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NEW DELHI TUBERCULOSIS CENTRE
ANNUAL REPORT
2016 - 2017
JAWAHARLAL NEHRU MARG, NEW DELHI-110002
Phone : Enquiry : 23234270, Office : 23239056
Fax : 23210549
e-mail : [email protected], [email protected]
Website : www.ndtbc.com
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CONTENTS
ANNUAL REPORT
2016-2017
Page No.
Message from Chairman 4
From Director’s Desk 5
About the Institute 7
Managing Committee 8
Scientific Advisory Committee 9
Ethical Committee 10
Senior Staff Members 11
Research and Publications 12
Participation in Scientific Events 30
Meetings 49
Clinical Section 50
Epidemiological Section 53
Public Health Section 56
Mycobacterium Laboratory 62
Training and Monitoring Section 68
Supervisory Activities 86
Library and Information Services 87
Administration 88
Summary of activities of New Delhi TB Centre 91
Annual Accounts 93
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As one of the oldest organization, New Delhi
Tuberculosis Centre since its inception in 1940
has a history of magnificent journey and growth
to achieve its present stature. Today it holds a
place of pride amongst the National level
institutes serving the patients with TB and other
respiratory diseases. It is a matter of immense
pleasure and satisfaction for me to be associated
with this Institution..
In recognition of its expertise in the areas of TB
research, training and programme implementation, it has been
designated as State TB Training and Demonstration (STDC) center
and Intermediate Reference Laboratory (IRL) under RNTCP for the
state of Delhi to monitor RNTCP activities and Designated Microscopic
Centers of Delhi state. It is the first STDC to start performing the
base line DST of all MDR cases for second line anti TB drugs and
planning to do universal DST for all smear positive cases, diagnosed
in the state.
The institute is providing necessary support to State TB Cell in
enhancing the notification of TB cases in Delhi by public as well as
private institutes. It is actively participating as a state partner in Active
Case Finding (ACF), a strategic national activity under RNTCP.
I extend my heartiest congratulations and wish that the institute
expand, diversify and flourish more and more to impart quality health
services to TB patients. I am grateful to Ministry of Health & Family
Welfare, GOI, Central TB Division and Government of Delhi for
extending their support to the Institute. I express my heartiest
gratitude and appreciation to the learned faculty, technical staff and
all employees for their constant cooperation and efforts towards
building this center as a national Institute.
Dr. L.S. Chauhan
Chairman
Message from Chairman
Dr. L.S. Chauhan
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Today, it is a matter of pride for me to represent
the annual report of glorious institute ‘New Delhi
Tuberculosis Centre’ who is giving full support
in journey to end the deadly disease. The Centre
which was established in 1940 as a ‘Model TB
Clinic’ has completed 76 years of its journey and
now grown up as a full fledged institute indulged
not only in clinical and diagnostic fields, it has
also established its role in RNTCP monitoring
and operational research in field of TB and
respiratory diseases. The report presents the summary of different
activities of the centre during the year.
When NTP started in India, NDTB Centre was one of the ten chest
clinics in Delhi. After introduction of RNTCP, in 1997 it became one
of the chest clinic of Delhi rendering DOTS services to half a million
of population of walled city of Delhi. Since then we have progressed
to become State TB Training & Demonstration Centre (STDC) as well
as Intermediate Reference Laboratory (IRL) for Delhi State providing
monitoring activities for DOTS and diagnostic services under RNTCP
for whole of Delhi State.
Patient care remains one of the basic activities of the Centre. During
the year, more than 10000 patients attended the OPD department of
the Centre for opinion and treatment. The doctors and staff of the
Clinical Section provide their service to the patients and after
diagnosing their disease, the patients are referred to their respective
areas for treatment. DOT Centre in its complex also put 455 patients
on treatment.
The laboratory of the Centre is equipped with all the newer diagnostic
techniques and is functioning as Intermediate Reference Laboratory
where we receive samples from 17 chest clinics of Delhi and providing
Dr. K.K. Chopra
From Director’s Desk
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its services for Line Probe Assay, solid and liquid culture and DST.
Epidemiology section of New Delhi Tuberculosis centre is involved in
various activities. Every year, the radiological examination of
employees of various organizations is done by the section. The faculty
of the section is also involved in running operational research projects.
The Centre is also engaged in teaching and training activities. The
interns and post graduate medical students of MAMC and V.P. Chest
Instituted are posted for teaching and training here. The Centre
runs a TB Supervisor Course in addition to the training of nursing
students from Ahilaya Bai College of Nursing, RML Hospital and Lady
Reading Health School.
This year, ECHO-MDR distance learning project is started in Delhi
State. The objective of the project is to build the capacity of Health
Service provider. Under this project, STDC, STO office, DRTB centers
and DTOs come together in virtual platform to discuss about various
issues, present cases and learn through didactic presentation by
experts. The NDTB Centre has participated in the project actively.
The staff of the centre is actively involved in conducting research
activities in clinical, bacteriological and programme related aspects.
During the year seven papers were published in journals
The details of the Centre’s activities are presented in the report. I am
grateful to the Ministry of Health & Family Welfare and Central TB
Division for the financial support. I am grateful to all the members of
Managing Committee, State TB Control Officer Delhi State and TB
Association of India for valuable help and cooperation for strengthening
the infrastructure at New Delhi Tuberculosis Centre.
Dr.K.K.Chopra
Director
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Established in 1940 as a Model TB Clinic, NDTB Centre has
now grown into a fully National level institute for TB and Chest
Diseases. The objectives of imparting health care, training and
education are being met in an integrated form here. In 1951, it was
upgraded to be the first TB demonstration cum Training Centre with
the assistance of WHO, UNICEF & Government of India. In 1966 it
became a referral Centre and was designated as State TB Training &
Demonstration Centre for the State of Delhi in the year 2005. Today
it has become a reality, as the Centre has gained due recognition
nationwide for excellence in the treatment of TB and respiratory
disease. The Government has supported both technically and
financially to make it an apex institute in the country.
With the objective of expansion of quality DOTS services to the entire
country, the Centre continues to render the services in the field of
TB and Respiratory diseases. The Centre aims at widening sources
both in terms of activities and access, and to sustain the achievements
for decades to come in order to achieve ultimate objectives of TB
control in the country. It is also actively participating in the National
level programme for finding TB cases under “Active TB Case Finding”
with Delhi TB State cell.
The Centre actively works in liaison with State TB cell on getting
positive results for all components of a new Stop TB Strategy. As an
IRL, the institute assists RNTCP in maintaining the global standards
through quality assurance for the laboratory in the state. The Institute
has been a guiding force in formulating policy in relation to
involvement of Private sector and Medical Colleges in the programme
for the management of pediatric TB and operational research along
with other various TB related research topics for more than 75 years.
ABOUT THE INSTITUTE
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MANAGING COMMITTEE
1. Dr. L.S. Chauhan ChairmanVice- ChairmanTuberculosis Association of India
2. Dr. V.K. Arora Member
Financial AdviserNew Delhi TB Centre/Vice Chairman (Research and Publication)Tuberculosis Association of India
3. The Additional Secretary & FA Member
Ministry of Health & Family welfare 4. The Joint Secretary (Health) Member
Ministry of Health & Family Welfare 5. The Deputy Director General (TB) Member
Central TB Division 6. Director Member
National Institute of TB & RespiratoryDiseases
7. The Director Member
VP Chest Institute 8. The Director of Health Services Member
Delhi Administration 9. Director Medical Services Member
New Delhi Municipal Committee 10. Honorary General Secretary Member
Delhi Tuberculosis Association 11. The Executive Director Member
Indian Railways 12. Secretary General Member
Tuberculosis Association of India 13. Director Member Secretary
New Delhi TB Centre
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Dr. L.S.Chauhan Chairman
Chairman
New Delhi Tuberculosis Centre
Dr.Ashwani Khanna Member
State TB Officer
Delhi State
Director Member
V P Chest Institute
Dr. Varinder Singh Member
Professor – Pediatric, Kalawati Hospital
Lady Harding Medical College
Shri G.P. Mathur Member
Ex-Statistician
New Delhi Tuberculosis Centre
Dr. M. Hanif Member
Bacteriologist
New Delhi Tuberculosis Centre
Dr. Nishi Aggarwal Member
Statistician
New Delhi Tuberculosis Centre
Dr. K.K.Chopra Member Secretary
Director
New Delhi Tuberculosis Centre
SCIENTIFIC ADVISORY COMMITTEE
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Director ChairmanVP Chest Institute
Dr. Sanjay Rajpal MemberChest PhysicianNew Delhi Tuberculosis Centre
Dr. M. Hanif ,K.M. MemberBacteriologistNew Delhi Tuberculosis Centre
Dr. Nishi Aggarwal MemberStatisticianNew Delhi Tuberculosis Centre
Dr. Chinkholal Thangsing MemberNGO – HIV Expert
Shri T.S. Ahluwalia MemberSecretary GeneralTuberculosis Association of India
Prof. Mala Sinha MemberFaculty of Medical ScienceDelhi University
Mr. Swetaketu Mishra MemberAdvocate
Dr. M. M.Singh MemberProfessorMaulana Azad Medical College
Shri G.P. Mathur MemberEx-StatisticianNew Delhi Tuberculosis Centre
Sh. Madan Mohan MemberDelhi TB Association
Sh. Sanjeev Gupta MemberCommunity Person
Dr. Shanker Matta Member SecretaryEpidemiologistNew Delhi Tuberculosis Centre
ETHICAL COMMITTEE
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Dr. K. K. Chopra Director
M.B.B.S., M.D., D.T.C.E.
Dr. Sanjay Rajpal Chest Physician
M.B.B.S., D.T.C.D., F.N.C.C.P.
Dr. Mahmud Hanif Bacteriologist
Ph.D.
Dr. Nishi Aggarwal Statistician
Ph.D.
Dr. Shanker Matta Epidemiologist
M.B.B.S., M.D.
Dr. Shivani Pawar Medical Officer
M.B.B.S., D.T.C.D.
Mr. D.C. Uppadhyay Administrative Officer
B.Com.
SENIOR STAFF MEMBERS
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Research papers published.
During the year 2016-17, the following research papers have been
published or submitted by faculty of the Centre:
1. Band pattern Analysis of mutations in Rifampicin resistance
strain of Mycobacterium tuberculosis by Line Probe Assay
in patients from Delhi, India. Himanshu Vashistha, M. Hanif, K.K. Chopra, A Khanna, D Shrivastava Indian Journal of
Tuberculosis, Vol.63, Issue 3;2017.
2. Rapid detection of multi drug resistance among multi drug
resistant tuberculosis suspects using line probe assay. Manoj
Kumar Dubey, U Bhardwaj, M. Hanif, K K Chopra, A Khanna,
S Saini, K K Dwivedi, H Vashishtha, Z Sidiq, V Ahmad, S Sharma
Asian Journal of Pharmaceutical and Clinical Research, Vol
10, Issue 1, 2017, 131-133
3. Baseline Resistance to Ofloxacin and Kanamycin Among
Multi-Drug Resistant Strains of M. tuberculosis Isolated at
an Intermediate Reference Laboratory in Delhi. Vasim Ahmad,
D Srivastava, M Hanif, Z Sidiq, K K Dwivedi, H Vashishtha, S
Sharma, S Saini, V K Bediraddy, K K Chopra, A Khanna Indian
Journal of Applied Research, Volume: 6, Issue: 8, August 2016
(586-588)
4. Molecular Line Probe Assay for the Detection of Multi Drug
Resistant Tuberculosis and Comparison of Results with
Conventional Solid Culture and Drug Susceptibility Testing.
Manoj Kumar Dubey, U Bhardwaj, M. Hanif, K K Chopra, A
Khanna, K K Dwivedi, H Vashishtha, S Saini, Z Sidiq, V Ahmad,
S Sharma Indian Journal of Applied Research, Volume: 6, Issue:
8, August 2016 (643-645)
RESEARCH AND PUBLICATIONS
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5. Rapid detection of extensively drug-resistant (XDR-TB)
strains from multidrug-resistant tuberculosis (MDR-TB) cases
isolated from smear-negative pulmonary samples in an
Intermediate Reference Laboratory in India. Himanshu
Vashistha, M. Hanif, S Saini, A Khanna , S Sharma, Z Sidiq, V
Ahmad, M K Dubey, K K Chopra, D Shrivastava Indian Journal
of Tuberculosis, Vol. 6 3 (2016) 1 46 – 150
6. Meso level multi – disciplinary approach for reduction of
initial defaulters in Revised National Tuberculosis
Programme, Delhi, India. Nandini Sharma, Meera Dhuria,
Nishi Aggarwal and K.K. Chopra, Paper accepted in Indian
Journal of Tuberculosis.
7. Newer Rapid Diagnostic Methods in MDR TB case
management. Himanshu Vashistha, M. Hanif and K.K. Chopra,
article published in 67 th TB seal campaign 2016. The
Tuberculosis Association of India.
Research papers presented in Conference
The 71st National Conference on Tuberculosis and Chest
Diseases was organized by Tuberculosis Association of Union
Territory, Chandigarh under the aegis of TB Association of India
at Department of Pulmonary Medicine PGI Chandigarh from
16th – 18th December, 2016. Dr. K.K. Chopra, Director and Dr.
M. Hanif, Bacteriologist NDTB Centre attended the conference.
Following research papers were presented in the conference:
1. Retesting by line probe assay of samples initially identified by
CBNAAT as MDR-TB
2. Recovery of M. Tuberculosis isolates from compromised sputum
specimens: a study of drug resistance pattern
3. Phenotypically confirmed XDR strains among MDR cultures
with uncommon mutations in rpob gene
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4. Efficiency of Genotype MTB DR plus in accurately identifying
Mycobacteria other than tuberculosis (MOTT) in clinical samples
5. Diagnosis of Multi Drug Resistant Tuberculosis by Line Probe
Assay and comparison with conventional culture and drug
susceptibility test
6. Comparison of liquid culture DST with LJ culture DST for
second line drugs Ofloxacin and Kanamycin among multi-drug
resistant strains of M. tuberculosis isolated at an intermediate
reference laboratory in Delhi
Research Projects
1. A multicentre study of diagnostic accuracy and feasibility
of the Xpert Ultra for detection of TB and Rifampicin
resistance in adults suspected of having pulmonary TB
The Xpert MTB/RIF (Xpert) assay, th e first near-patient test
for tuberculosis (TB), detects Mycobacterium tuberculosis (Mtb)
with a limit of detection (LOD) of 133 CFU/ml sputum, and
detects mutations in the Mtb rpoB gene which cause Rifampicinresistance (RIF-R). However, despite high sensitivity overall,
Xpert sensitivity is only 60 – 80% in smear-negative TB. Also,
small numbers of false RIF-R have been reported recently,usually due to abnormal real-time PCR curves or miss-
identification of RIF-susceptible (RIF-S)
synonymous rpoB mutants as RIF-R. A new molecular TB testwith an LOD equivalent to the 10 – 100 CFU/ml LOD of liquid
culture and improved RIF-R detection is needed. Thenew Ultra assay is much more sensitive than Xpert, and is likelyto be as sensitive as liquid TB culture. Ultra detects RIF-R asefficiently as Xpert; but the specificity of Ultra RIF-R is likelyto be higher due to improvements in assay design.
The Ultra assay should significantly increase TB detection insmear-negative patients and provide more reliable RIF-Rdetection.
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FIND Geneva is leading an eleven-site, eight-country study in
partnership with the TB clinical diagnostic research consortium
to assess the accuracy and feasibility of the Xpert Ultra test in
adults suspected having pulmonary TB. In case of India, ultra
study was initiated at NDTB, New Delhi along with few other
sites which were geographically different. Two of the primary
objectives of the study was to estimate and compare the
sensitivity and specificity of the Ultra versus the standard Xpert
MTB/RIF test for the detection of culture-positive pulmonary
TB and for Rifampin resistance detection compared to the optical
phenotypic drug susceptibility testing.
The project was funded by FIND Geneva and it started from
March 2016 and completed on March 2017. All the objectives
were fulfilled and the results obtained in the study have been
submitted to FIND Geneva.
2. Accelerating TB Notification from the private health sector
in Delhi, India.
The project has been completed during 2016-17 and report
has been submitted to Delhi State TB Cell. The study showed
that there was a significant improvement in TB case notification
from the private sector and provided them NIKSHAY login for
future notification of tuberculosis cases from their set-up as
per RNTCP guidelines.
3. SMS for sure project
SMS for sure project was undertaken by NDTB with the aim of
assessing the impact of SMS on TB treatment adherence. For
this project an IT company was employed by the name of Shreya
Web Solutions. The aim of this project is to see whether SMS
has any role in decreasing default rates among TB patients.
Activities undertaken and outcomes till date:
· In the month of October 2015, 239 DOT providers were trained
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in 8 batches .It was a one day training programme whereby
they were explained about their role in the project.
· DTOs of all districts were sensitized during quarterly meet.
· A server was installed at NDTB in the month of October and
the activity was pilot tested in first few days.
· A toll free number has been initiated for the benefit of DOT
providers.
· The process: 6000 newly diagnosed patients were randomized
into 3 groups by the server. Group 1 would received enrolment
conformation SMS, weekly motivational SMS and a reminder
SMS, as and when they missed a dose. Group 2 patients received
enrolment conformation SMS, a reminder SMS when they
missed a dose. Group 3 patients were not received any SMS
except the study enrolment conformation SMS.
· The project was formally initiated from 2nd November 2015. A
server was installed as mentioned earlier, at NDTB centre and
2 counsellors were hired by the IT company to telephonically
address all queries of DOT providers.
• Outcome: The project is ongoing and 6000 patients were
enrolled on 7th July 2016.Data on missed doses by patients is
being compiled on the server. The results of 6000 patients
registered in July 2016 ( November 2015-July2016)is as follows:
(Updated as on 31st March 2017)
Group 1: 2000
Group 2:2000
Group 3 :2000
Total No. of Missed Doses : 87
Total No. of Default : 83
Total No. of Patient Died : 43
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Total number of “Failure : 32
Total No. of patients who have
successfully completed treatment : 2178
Transferred out : 22
Total : 2445
*Outcome of patients are awaited
It was decided that analysis would be undertaken for the period
from 2nd November 2015 to 7th July 2016. Hence Patients
registered between 2nd November 2015 till 7th July 2016, whose
outcome were available would be included for analysis.
4. Framework of TB care in prisons
A project titled “Framework of TB care in prisons” is being
managed by NDTB and the State TB Cell. Aim of this project is
to estimate the burden of TB among prison inmates at Tihar
Jail, frame the operational modalities for early detection of TB
and drug resistant TB at Tihar Jail. Lastly, to mobilize
standardized TB care practices among the jail inmates (during
their stay in prisons and adequate referral thereafter). Talks
are on with the Tihar jail officials to take up this project
5. TB case finding activities at night shelters of Delhi
New Delhi Tuberculosis Centre was involved with the aim the
sensitization programme for Care Takers of Night Shelter with
the objective of identifying TB suspects coming to stay at night
shelters of Delhi. NDTB is planning to undertake this project.
Aim of this project is to ensure that staff of night shelters is
trained as DOT providers so that they can identify TB suspects
and who are further referred to the nearby chest clinic for
treatment. Long term objective is to open DOT centres in some
of the night shelters.
In this regard a meeting was held on 25th April 2016 at NDTB
Centre to discuss modalities about sensitization programme
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for care takers of night shelter. Staff from Epidemiology section,
NDTB, District TB officers, WHO consultant and representative
from Delhi TB Association were involved. The care takers and
supervisors were sensitized about symptoms, diagnosis,
treatment and prevention of TB. IEC material and sputum cups
were also provided to all night shelters. Three teams were
identified to train staff of all districts by three teams of NDTB
Centre, Delhi TB Association and Lok Nayak Chest Clinic. 22
chest clinics were identified which had night shelters in their
district. Visits were undertaken from May 2016 to July 2016
for all the 22 districts. Every team had to conduct at least one
sensitization programme once a week in their chest clinic on
every Friday by using any method i.e. flip chart, presentation
slides and lecture method etc. In every district, MOTC, STS
and NGO representative were involved to conduct and coordinate
the activity.
The sensitization was successfully imparted to staff of night
shelters in all the districts. After this activity, every district is
regularly reporting the TB cases put on treatment among
inmates of night shelters in their monthly report. Care takers
have also been trained to act as DOT providers for TB cases
detected in their night shelters.
6. Accelerating access to quality TB diagnosis for pediatric
cases.
This was started with efforts of RNTCP and FIND at New Delhi
Tuberculosis Centre. Under this initiative, FIND have setup high
throughput molecular lab at our site, catering exclusively to
the TB diagnostic needs of pediatric population. This study
provides accurate evidence based on same day diagnosis in
line with internationally accepted standards of TB care with no
cost to patient or provider both in private and public sector.
This diagnostic option has been introduced at the existing
RNTCP labs for the processing of pediatric specimens such as
sputum, gastric lavage, BAL, induced sputum, lymph node
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aspirated, etc. for use in Xpert MTB/RIF. Such an effort came
as a big financial relief to poor patients and obviating the
necessity to visit private labs and related huge costs.
All pediatrician both in public and private sector in the city
referred pediatric suspects to our laboratory. The specimens
were tested on the same day and the results communicated to
referring provider electronically (E-mail and SMS) and
simultaneously notified to RNTCP under Nikshay.
Overall 13,363 pediatric patients were tested between April 16
to March 17 under this project, out of which 2570 were non-
respiratory specimens. The project has demonstrated the
feasibility of extending Xpert test to non-sputum specimens
from children with a very high proportion of interpretable results
with more than a threefold increase in TB case detection over
smear microscopy and detection of significant number of
rifampicin resistant TB cases. The project has also shown the
utility of offering up front Xpert testing to pediatric presumptive
TB and DR-TB patients under programmatic conditions.
CBNAAT Performance:
Project: Accelerating access to quality
TB diagnosis for Pediatric Cases
(For the period from April 2016 to March 2017)
Total number of tests performed 13109
Total number of MTB not detected 11682
Total number of MTB detected and RIF sensitive 1136
Total number of MTB detected and RIF resistant 191
Number of Invalid test 100
Total number of EP-TB sample processed 2570
Total number of MTB detected and RIF sensitive 283
Total number of MTB detected and RIF resistant 80
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Type of specimen received and X-pert results from
April 2016 to March 2017
Type of Specimen No. of Xpert Positivity
Specimen Positive (%)
Abscess 11 3 27
Ascitec Fluid 142 3 2
BAL 392 55 14
CSF 1162 84 7
ET secretion 32 5 16
FNAB 82 28 34
Gastric Aspirate 7875 529 7
Gastric Lavage 66 4 6
Induced Sputum 82 13 16
Lymph Node 177 86 49
Pericardial Fluid 25 3 12
Pleural Fluid 652 32 5
Pus 379 156 41
Sputum 2009 322 16
Tracheal Aspirate 23 4 17
Grand Total 13,109 1,327
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MD/MS/DNB Thesis being conducted in collaboration
1. Clinical correlates of drug sensitivity pattern in children with
tuberculosis : A cross sectional study
(MD Thesis of PG student of Department of Pediatrics, Lady
Harding Medical College,)
The burden of childhood tuberculosis (TB) reflects the ongoing
TB transmission in a community. About one million children
fall sick with TB every year. It is seen that the pattern of drug
resistance in children of a community generally mirrors that of
the adult population. Children rarely have acquired resistance
because childhood TB is usually paucibacillary with small
organism load. Hence it is unlikely that resistant mutants will
occur and be selected. Childhood TB can be used as a sentinel
marker to evaluate the effectiveness of a TB control programme.
Surveillance of drug resistance is therefore essential because
trends in primary drug resistance or initial drug resistance
provide an indication of the effectiveness of the treatment
regimen while drug resistance rate in patients with a history of
previous treatment can indicate failures in the management of
the disease. It is evident from the literatures that there is paucity
of information on drug sensitivity pattern of isolates from
children with TB especially in India. So the present study is
being carried out to observe pattern of drug sensitivity and
emerging drug resistance in children with TB. Children between
0-14 years of age diagnosed with TB (free from known
immunodeficiency and serious illness) are being included in
the study. Mycobacteriological examination like Xpert MTB Rif,
Line Probe Assay and MGIT Culture and DST will be done.
Result generated will help in understanding pattern of
sensitivity and resistance in children suffering from TB so that
better and timely treatment management can be offered and
understood.
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2. A study of the course of illness in children with
extrapulmonary tuberculosis on standard chemotherapy
(MD Thesis of PG student of Department of Pediatrics, Lady
Harding Medical College,)
Childhood tuberculosis (TB) accounts for 10 – 20% of all TB
cases in high burden cases. The most common form of
tuberculosis is pulmonary i.e. about 60-80% cases and rest
20-40% account for extrapulmonary TB (EPTB). The most
common form of EPTB is lymph node. Other site of
involvement includes central nervous system, abdominal,
skeletal, etc. The problem in EPTB lies in diagnosing the
cases and thereafter follow-up the cases to assess end point
of cure. Symptom resolution is highly variable in all forms of
EPTB and most of the understanding about the disease course
comes from earlier studies on the natural history of disease.
The exact pattern, timing of symptom response to modern
day therapy and microbiological/ radiological improvement
in patients after first time exposure to therapy especially in
Indian setting is less clearly stated in the available literatures.
Studies that have evaluated the course during treatment are
old enough when the drug regimens used were entirely
different from modern day chemotherapy. So the present
study was designed to study the course of illness in children
with EPTB on standard chemotherapy. 75 children above 06
months and upto 18 years of age with newly diagnosed EPTB
were included in the study. Diagnostic tests like Xpert MTB
Rif and MGIT Culture and DST were done during the course
of treatment. Results generated from the study are under
analysis.
3 To study the role of Cartridge Based Nucleic Acid
Amplification Test (CBNAAT) in early diagnosis of pulmonary
23
tuberculosis and primary drug resistance in HIV positive
patients
(MD Thesis of PG student of Department of Medicine, PGIMER,
Dr. Ram Manohar Lohia Hospital)
Tuberculosis (TB) and Human Immunodeficiency Virus (HIV)
have been closely linked since the emergence of AIDS. The
lifetime risk of TB in immunocompetent persons is 5% to 10%,
but in HIV positive individuals, there is a 5% to 15% annual
risk of developing active TB disease. Studies have shown that
pulmonary TB (PTB) in HIV positive patients remains the most
common opportunistic infection in India ranges from 17% to
23%. Sputum microscopy in HIV positive patients is found to
be less reliable in diagnosis of TB. Further, increasing number
of patients with drug resistant tuberculosis (DR-TB) creates
more challenges in its treatment. Conventional diagnosis of
DR-TB relies on bacterial culture and drug susceptibility
testing, a slow and cumbersome process. Thus, it is very
important to identify PTB at an earliest so that it can be
managed appropriately. Cartridge Based Nucleic Acid
Amplification Test (CBNAAT) is one of a recently developed
diagnostic modality which can simultaneously detect TB and
perform drug susceptibility testing of one of the key drug –
Rifampicin within few hours. So, the present study was carried
out to study role of Cartridge Based Nucleic Acid Amplification
Test (CBNAAT) in early diagnosis of pulmonary tuberculosis
and primary drug resistance in HIV positive patients. 100 HIV
positive subjects greater than 18 years of age presented with
symptoms/ x-ray suggestive of TB were included in the study.
Mycobacteriological examination like Xpert Rif and MGIT
Culture of all the subjects were done. Results generated are
under analysis.
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4. Comparison of Line Probe Assay with conventional solid
culture and drug susceptibility testing to detect multi drug
resistant tuberculosis
(Ph.D Thesis submitted at Maharaj Vinayak Global University,
Jaipur)
The global threat of multidrug-resistant tuberculosis (MDR-
TB) to TB control, underscores the importance of prompt and
rapid identification of such resistant strains. Isoniazid and
Rifampicin are the key first line anti-tuberculosis drugs and
resistant to these drugs is likely to result in treatment failure
and poor clinical outcomes. As per an estimate, India has the
largest number of MDR-TB cases amongst notified TB patients
of any country.
Newly developed molecular based methods have advantages
over conventional phenotypic methods in terms of both accuracy
and turnaround time. The genotype MTBDR plus assay is
commercially available. Line Probe Assay from Hain life
sciences, Germany is designed to detect most important gene
mutations conferring resistance to Isoniazid and Rifampicin.
Although this assay has been studied in several laboratories,
there is wide variation in circulating M. tuberculosis strains
across the globe. Hence in this study, it was attempted to
evaluate the performance of LPA for the rapid detection of MDR
TB. The results of this molecular method was compared with
that of the conventional phenotypic drug susceptibility to
demonstrate the sensitivity, specificity and accuracy of LPA with
its capacity to shorten the time required for TB diagnosis
compared to that of conventional method.
5. Rapid screening of second line anti tuberculosis drugs
resistance among MDR TB suspects by Liquid DST (MGIT
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960) and comparative evaluation with Solid Proportion
Method.
(PhD thesis of student, Department of Life Science, Jaipur
National University, Jaipur,)
Rapid and accurate diagnosis of the Mycobacterium
tuberculosis and its drug susceptibility pattern, is essential for
timely initiation of treatment and ultimately, control of the
disease. The importance of diagnosing XDR-TB among MDR-
TB has been the driving force behind this study, more rapidly
XDRs can be detected among multi drug resistant patients.
This will lead to more rapid implementation of the best therapy
for given patients. Therefore this study was initiated with the
objectives, a) Screening of Kanamycin and Ofloxacin resistance
in suspected MDR TB patients by Liquid DST method (MGIT
960) and Standard proportion method (Solid LJ DST), b)
Comparison of sensitivity and specificity of Liquid DST (MGIT
960) for Kanamycin and Ofloxacin with Standard proportion
method (Solid LJ DST), c) Evaluation of Diagnostic accuracy of
both the methods in discordant results for the detection of
XDR-TB, d) Detection of mutations imparting discordant
resistance by DNA sequencing. In this study, all patients were
subjected to sputum-smear microscopy for acid-fast bacillus
(AFB) by fluorescence microscopy. All sputum smear positive
specimens were tested for primary drug susceptibility by Line
Probe Assay (LPA) method while sputum negative samples were
directly cultured on MGIT system and when culture become
positive these samples subjected to LPA. Diagnosed MDR
specimens subjected to culture on MGIT 960 and Lowenstein-
Jensen (L-J) slopes. All positive culture were further tested for
drug susceptibility testing (DST) by MGIT 960 as well as by LJ
proportion method for two drugs namely ofloxacin and
kanamycin. Study is under process.
26
6. Genetic Polymorphism of rare mutations in rifampicin
resistance of Mycobacterium tuberculosis infected patients.
(PhD thesis submitted to School of Life Sciences at Jaipur
National University, Jaipur,)
The multidrug-resistant TB (MDR-TB) crisis continues, with an
estimated 480 000 new cases in 2013. Genetic polymorphism
is the occurrence of two or more alleles at one locus in the
same population, and each with appreciable frequency. It is
therefore equally important to identify the genetic origins of M.
tuberculosis inter strain pathobiological differences in order to
progress the eventual association of strain genotypes with
patient clinical phenotypes. Several studies showed frequency
of mutations outside RRDR region (hot spot) and it is also
present in Indian M. tuberculosis isolates but their role and
impact in polymorphism is not yet well studied. Therefore, in
the present study we attempted to rapidly screen drug
resistance among smear positive sputum samples by the use of
LPA in Delhi region. The results of the molecular diagnostic
method was compared with that of the phenotypic drug
susceptibility test (MGIT 960 DST) to demonstrate the
sensitivity, specificity and accuracy of LPA with its capacity to
shorten the time required for TB diagnosis compared to that of
the phenotypic DST method. The virulence of Mycobacterium
tuberculosis and its genetic polymorphism prevalence in clinical
isolates was studied through band pattern analysis in DNA
strips of Line Probe Assay. DNA Sequencing was performed to
confirm the mutations reported in this study which also
confirmed Novel mutations. The technique described in our
study may prove to be useful for identifying MDR-TB. The
presence of uncommon mutations confirms genetic
polymorphism that may require treatment targeted at both
drug-resistant and drug-susceptible phenotypes for the better
management of patients with MDR-TB.
27
7. Diagnosis of MDR & XDR-TB in Smear Negative pulmonary
and Extra pulmonary specimens from drug resistant TB
suspects
(Ph.D thesis of student Maharaj Vinayak Global University,
Jaipur)
The emergence and spread of multidrug-resistant tuberculosis
(MDR-TB) and extensively drug resistant tuberculosis (XDR-
TB) are a major medical and public problem threatening the
global health. A lot of work has been done on smear positive TB
patients but sparse data is available on smear negative cases.
Due to low mycobacterial load in early stage of infections, such
patients are declared as smear negative even though they are
actually positive. Such patients continuously spread infection
in their close vicinity. Recovery of mycobacterium from such
smear negative TB patients and the pattern of drug sensitivity/
resistance observed in these cases can help in better
management of these cases. Therefore, this study was initiated
with the aim to determine the recovery of M. tuberculosis in
smear negative samples through liquid culture using MGIT 960
and also to determine the number of drug resistant cases
through Line Probe Assay. DST for second line drugs using
MGIT was planned once culture positives were observed.
Though intake of samples and the testing have been completed
the data analysis is under process. This data on diagnose of
drug resistance in smear negative and culture positive cases is
very important.
8. Diagnosis of Multidrug Resistance Tuberculosis among
suspects using molecular Line Probe Assay
(M.Sc dissertation submitted at Jaipur institute of
Biotechnology, Maharaj Vinayak Global University, Jaipur)
28
Globally, tuberculosis (TB) cases continue to be on the rise
despite aggressive public health interventions. India bears a
quarter of world’s tuberculosis burden and has the highest
number of newly diagnosed cases annually. Drug resistant TB
is the most important factor that threatens to disrupt the gains
achieved in tuberculosis control. A prolonged time of diagnosis
of six to eight weeks taken by the conventional culture and
DST leads to the patients being treated with an inappropriate
drug regimen, which results in the selection of drug resistant
mutant strains and their continuous spread in the community.
Many rapid methods have been developed to address this issue.
A Genotypic method exploits the fact that MDR arises due to
random mutations, mainly found in rpoB, katG and inhA. Line
probe assay (LPA) is one of the rapid molecular methods which
are used for the screening and diagnostic for pulmonary
tuberculosis. Therefore, this study was conducted using LPA
for the diagnosis of MDR-TB among the MDR-TB suspects.
Smear positive subjects were subjected to DNA extraction,
followed by amplification and development of blot by reverse
hybridization. The data obtained correlate well with earlier
reports from other studies.
9. Isolation of Mycobacterium from smear negative multidrug
resistant TB suspects using liquid culture (MGIT 960)
(M.Sc dissertation submitted at Jaipur institute of
Biotechnology, Maharaj Vinayak Global University, Jaipur)
Acid fast staining of clinical material, followed by smear
microscopy remains the most frequently used microbiological
test for detection of TB. The major drawback of sputum smear
microscopy is its poor sensitivity. Also drug susceptibility status
cannot be ascertained from smear microscopy. Culture of M.
tuberculosis in clinical specimens is substantially more sensitive
than smear microscopy. Culture can be performed using solid
29
media such as Lowenstein- Jensen or liquid media such as that
used in commercially available automated systems. A major
drawback with LJ culture method is that it is time consuming.
On the other hand, liquid culture based methods have shorter
TAT. The MGIT 960 system (supplied by BD) is currently
recommended by WHO as well as RNTCP. Therefore, this study
was initiated with the objective: To isolate Mycobacterium
tuberculosis from specimens collected from sputum smear
negative MDR-TB suspects using liquid culture (MGIT 960) and
to compare both techniques: liquid culture (MGIT) and solid
culture (LJ medium) with regard to Mycobacterium tuberculosis
isolation. Sputum samples collected at DMC level were
transported to IRL. Smears were prepared, stained by auramine
and were examined under the microscope as per RNTCP
guidelines. All smears declared as negative were further processed
for liquid as well as solid culture. At the end of the study, the
results were compared and good correlation was observed
between both the methods. Positive growth was observed much
early in liquid culture when compared with LJ culture.
30
PARTICIPATION IN SCIENTIFIC EVENTS
1. Review meeting of notification project was held on 9th April
2016 in New Delhi TB Centre. Six health workers of the project
posted in the districts attended the meeting. The record of the
visits made by them to private practitioners and laboratories
were reviewed and further guidelines for working finalised.
2. Workshop to review roll out of Bedaqueline in Delhi state with
The Union was conducted on 19th April 2016 in New Delhi TB
Centre. Representative from The Union – State TB Cells, two
project sites attended the workshop to finalise the activities to
roll out the Bedaqueline at the earliest.
3. A training workshop for coordinating sensitization of night
shelters in 25 districts was held on 25th April 2016. Three
teams of NDTBC, Delhi TB Association and Lok Nayak Chest
Clinic were trained to complete the process in two weeks.
4. One day workshop for review of “SMS for sure” project was held
on 26th April, 2016. All the DOT providers with post paid mobile
connections participated in the workshop. Reasons for low
registration in the project were reviewed and resolved. All issues
related to the project were discussed.
5. One day sensitization of DTOs was conducted in NDTB Centre
on 29th April 2016 about the newly formed schemes of PPMs.
6. A Review meeting of notification project was held on 6th May
2016. The health workers posted in six districts from the project
presented their report about notification of cases by private
practitioners and laboratories in their respective districts.
7. A CME for private practitioners under ‘TB notification’ project
was conducted on 7th May 2016 in Narela Chest Clinic. Private
31
practitioners of the area were invited for the CME. Dr. K.K.
Chopra, Director delivered the lecture on TB notification which
was followed by discussion. Similar activity was conducted on
24th May 2016 in Jhandewalan Chest Clinic.
8. Delhi state RNTCP review meeting was held on 11th May 2016
in New Delhi TB Centre. Dr. K.K. Chopra, Director, STDC
presented the analysis of quarterly reports of 25 chest clinics.
Principal Investigators of different OR projects being conducted
in Delhi state presented the update on the projects.
9. Quarterly review of PMDT activities of Delhi state for 1st quarter
2016 was held on 18th May 2016 in NDTB Centre. Nodal officer
of culture DST labs and DRTB centres presented their activities
for the quarter. Issues related to newly established CBNAAT
labs and nikshay entries were discussed and appropriate
decisions were taken.
10. Sensitization programme held for 3rd year B.Sc (H) nursing
students of RAK College of Nursing on 20th May 2016 in which
they were sensitized about disease, treatment and prevention
of tuberculosis and role of nurses in care of TB patients.
11. SPYM (night shelter and drug de-addiction centre), Darya Ganj
was visited on 20 th May 2016 by Dr. Shanker Matta,
Epidemiologist and Ms. Shadab Khan, MSW to re-sensitized
the staff and volunteers working with those children. The
sensitization programme was held in form of group discussion
where participants shared their problems currently faced with
regard to TB patients and were given possible answers for their
queries.
12. Five days workshop for training of counsellors was conducted
in NDTB Centre with The Union from 23rd to 27th May 2016. A
batch of ten counsellors for MDR cases to be posted in different
parts of the country was trained during the workshop. Faculty
32
of NDTB Centre, the Union and State TB Cell took lectures and
field visits during the workshop.
13. A CME for private practitioners under ‘TB notification’ project
was conducted on 24th May 2016 in Pili Kothi Chest Clinic in
which Dr. Shanker Matta, Epidemiologist delivered a lecture
on TB notification.
14. A meeting of scientific committee of RBIPMT was held on 25th
May 2016. Dr. K.K. Chopra, Director, Dr. M. Hanif,
Microbiologist and Dr. Nishi, Statistician attended the meeting
as member. Thesis protocols of DNB students were discussed
in the meeting. All the protocols were recommended after few
minor modifications.
15. A CME for members of Delhi Medical Association was organised
by The Union and State TB Department on 28th May 2016 in
DMA Hall. Dr. K.K. Chopra, Director was one of the facilitator.
He delivered lecture on TB notification and Standards of TB
care in India. About 50 doctors attended the CME.
16. Dr. Shanker Matta, Epidemiologist attended Protocol
Development Workshop from 30th May 2016 to 3rd June 2016conducted by National Institute for Research in Tuberculosis,
ICMR, Chennai.
17. A CME for private practitioners under notification project was
conducted in Shastri Park Chest Clinic on 31st May 2016. About
20 private practitioners attended the CME. Dr. Sandeep Saini,
DTO Shastri Park Chest Clinic delivered a lecture on overview
of RNTCP and Dr. K.K Chopra, Director STDC delivered a lecture
on TB notification. This was followed by discussion.
18. Regional PMDT review and planning meeting of North Zone
states was held from 8th to 10th June 2016 in Chandigarh by
Central TB Division. Delhi state was part of the review meeting.
33
Dr. K.K. Chopra, Director and Dr. M. Hanif, Microbiologist were
part of Delhi state team. Dr. K.K. Chopra, Director presented
the PMDT activities of Delhi state which was followed by group
work to assess the preparedness of state for universal DST roll
out in Delhi state. It was proposed to roll out this service in
Delhi state from first quarter of 2017.
19. The Tuberculosis Association of India (TAI) proposes to adopt a
“district” and help effectively implement the RNTCP in a focused
way so that it can be made “TB free district” within a reasonable
time frame. To start with, it has been decided to adopt districtGaya in Bihar as this is the poorest and most neglected one.
Dr. K.K. Chopra, Director was nominated as member secretary
of a central team to make Gaya (Bihar) as TB Free District. The
team was proposed by Vice Chairman, TAI and approved by
Chairman, TAI (Director General Health Services).
20. A CME was organized for private practitioners under
“Accelerating notification project” at NDMC Chest Clinic on 13th
June 2016. Twenty private practitioners attended the CME.
Dr. K.K. Chopra, Director delivered a lecture on ‘TB notification’
which was followed by discussion.
21. A meeting with representatives of ECHO India project was held
in NDTB Centre on 14th June 2016. The place and modalities
of setting up one ‘HUB’ centre at STDC under the project were
finalized. The ‘HUB’ will be used for training of DTOs and para
medical staff of RNTCP Delhi and also to review their periodical
reports.
22. On site evaluation of IRL of NDTB Centre was held from 15th
to 17 th June 2016. A team from National Reference
Laboratory visited laboratory of NDTB Centre, 3 CBNAAT sites
of Delhi and 3 DMC of Delhi for their functioning and record
keeping.
34
23. Sensitization of care takers and supervisors of night shelters
under different chest clinics is being conducted. Dr. K.K.
Chopra, Director alongwith District TB Officers of respective
chest clinics discussed with staff of night shelters regarding
referral of TB suspects and to work as DOT Providers for patients
diagnosed among intimates of night shelters. The details of
visits is as under:
a) BSA Chest Clinic on 18th June 2016.
b) Ch. Desiraj Chest Clinic on 25th June 2016
c) BJRM Chest Clinic on 29th June 2016
24. Meeting of editorial board of IJT was held on 23rd June 2016 in
TB Association of India. Dr. K.K. Chopra (Director) participated
in the meeting as Associate Executive Editor of the Journal.
During the meeting, TB Seal designs for the year was discussed
and it was decided to keep ‘Dolls of India’ as TB seal design of
this year.
25. SPYM (night shelter and drug de-addiction centre), Darya Ganj
was visited on 20th June 2016 by Dr. Shanker Matta,
Epidemiologist and Ms. Shadab Khan, MSW to re-sensitize the
staff and volunteers working with those children. The
sensitization programme was held in form of group discussion
where participants shared their problems currently faced with
regard to TB patients and were given possible answers for their
queries.
26. A meeting to assess the preparedness of Delhi state for adopting
universal drug sensitivity testing for diagnosed TB cases was
held on 1st July 2016. Representatives of Central TB Division,
WHO, Delhi state RNTCP team and STDC faculty participated
in the meeting.
35
27. A review meeting of health workers of TB notification project
was held on 1st July 2016. To discuss progress of the project
and further steps to be taken were reviewed.
28. A CME was organized for private practitioners under
“Accelerating notification project” at Patparganj Chest Clinic
on 5th July 2016. Twenty private practitioners attended the
CME. Dr. K.K. Chopra, Director delivered a lecture on ‘TB
notification’ which was followed by discussion. Similar CME
was also organized in Shahdara Chest Clinic on 11th July 2016.
29. The International Union Against TB and Lung (The Union)in Delhi organized a CME in collaboration with RNTCPon 09 th July,16. The theme of the CME was “Recentupdates in TB Care and Control”. Dr. K.K. Chopra, Directordelivered a lecture on “Standards of TB Care in India” during
the CME.
30. Sensitization of care takers and supervisors of night shelters
under different Chest Clinics is being conducted. Dr. K.K.
Chopra, Director alongwith District TB Officer visited Shahdara
Chest Clinic on 11th July 2016 to discuss with staff of night
shelters regarding referral of TB suspects and to work as DOT
Providers for patients diagnosed among intimates of night
shelters.
31. TB Association of India has adopted Gaya district of Bihar to
make it TB Free. Dr. K.K Chopra, Director is member secretary
of the committee constituted for this purpose. First meeting of
the committee was held on 15th July 2016. Members discussed
the plan of project implementation in the meeting.
32. A CME was organized in Dr MC Joshi Hospital under R.K.
Mission Chest Clinic on 21st July’16. Dr. K.K. Chopra, Directordelivered a lecture on “Standards of TB Care in India” during
the CME.
36
33. Two days training of District TB Officers of Delhi state entitled
“Training of daily anti-TB treatment and 3IS (ICF, IPT, AIC)
strategy under TB HIV collaborative activities was held in New
Delhi TB Centre on 25th and 26th July 2016. Facilitators were
from NACO, State RNTCP Cell, WHO and Maulana Azad Medical
College.
34. Meeting of Ethical Committee of NDTB Centre was held on
27th July 2016. A project entitled “Feasibility and Acceptability
of Screening TB suspects in night shelters of Delhi” facilitated
by ICMR, Chennai and funded by Global Fund was discussed
for ethical clearance. The project has already been cleared by
National OR Committee. After detailed discussion the project
is cleared.
35. Meeting to discuss short term schedule for MDR TB cases was
held on 27th July 2016 in Central TB Division. Dr. K.K Chopra
(Director) and Dr. M. Hanif (Microbiologist) participated as
national experts. Issues of second line LPA, relaxation in norms
to introduce bedaquiline were also discussed.
36. Dr. K.K. Chopra, Director was panelist for live IMA webcast on
28th July 2016. Latest updates on TB management and
prevention were discussed.
37. Core group meetings of ECHO project was held on 4th August
2016 in NITRD. The purpose of meeting was to give orientation
of the project and its utility for RNTCP in Delhi. Dr. K.K. Chopra,
Director attended the meeting as Delhi State RTNCP
representative.
38. A meeting with nodal officers of DRTB centres and District TB
Officers was held in NITRD on 5th August 2016. Purpose was to
sensitize DTOs about ECHO Project, the modalities and timeline
for setting up hubs in DRTB Centres. Dr. K.K. Chopra, Director
attended the meeting.
37
39. Delhi TB Association organised one day sensitization workshop
for community volunteers on 5th August 2016. Dr. K.K. Chopra,
Director delivered a lecture on Hazards of irregular treatment
and prevention of MDR TB.
40. Delhi state RNTCP review meeting was held on 10th August
2016 in New Delhi TB Centre. Dr. K.K. Chopra, Director, STDC
presented the analysis of quarterly reports of 25 chest clinics.
Principal Investigators of different OR projects being conducted
in Delhi state presented the update on the projects.
41. One day orientation programme for doctors of Malviya Nagar
Hospital was organised on 12th August 2016. Dr. M. Hanif,
Microbiologist and Dr. Zeeshan facilitated the programme.
Doctors were briefed about CBNAAT, its use and clinical
significance in diagnosis of TB and MDR TB.
42. Quarterly review of PMDT activities of Delhi state for 2nd quarter
2016 was held on 17th August 2016 in NDTB Centre. Nodal
officer of culture DST labs and DRTB centres presented their
activities for the quarter. Issues related to newly established
CBNAAT labs and nikshay entries were discussed and
appropriate decisions were taken.
43. On 20th August 2016, 31 students of final year students of
B.Sc (Hons) Nursing of Safdarjung College of Nursing were
sensitized about care of TB patients under RNTCP in detail i.e.
TB as a disease, treatment modalities etc. and also role of nurse
for care of TB patients.
44. A meeting to make preparation for setting up of gene sequences
and IGRA lab in NDTB Centre was held on 1st September 2016
in NDTB Centre. The meeting was attended by representatives
from WHO, Central TB Division and Delhi state RNTCP.
45. Training for clinicians and researchers in GCP (Good Clinical
38
Practices) and Schedule Y to be followed for conducting clinical
and drug trials was held at NITRD on 2nd September 2016. Dr.
K.K. Chopra, Director attended the training.
46. Ethical committee meeting of NITRD was held on 2nd September
2016. Dr. K.K. Chopra, Director attended the meeting. Three
research protocols and two drug trial notifications were
discussed.
47. A sensitization programme for health workers of SOSVA NGO
was held in NDTB Centre on 7th September 2016. They were
briefed about symptoms of TB diagnosis, management and
prevention of TB. Twelve health workers attended the
sensitization programme.
48. WHO-RNTCP-IPC National collaborative workshop on Causality
Assessment for Pharmacovigilance of Anti-Tubercular Medicines
in India was conducted by Central TB Division with WHO on 8th
and 9th September 2016. Dr. K. K. Chopra, Director and Dr.
Shanker Matta, Epidemiologist attended the workshop.
49. Training of trainers for New Technical and Operative Guidelines
under RNTCP was held from 18th to 23rd September 2016 at NTI
Bangalore. Dr. K.K. Chopra, Director participated in the
training programme.
50. A meeting regarding research project “Comparison of pooled
sample examination versus single sample ability to detect drug
resistance ‘was held on 27th September 2016 in Paediatric
Department of Kalawati Hospital. Dr. K.K. Chopra, Director
and Dr. M. Hanif, Bacteriologist are co-investigators for the
study approved by National OR Committee. The revised
proposal of the study was discussed and prepared to be
submitted in Central TB Division for funding.
39
51. Two days workshop was held by WHO and Ministry of Health &
Family Welfare in Delhi from 28th and 29th September 2016
regarding impact of air pollution on health. Dr. K. K. Chopra,
Director and Dr. Shanker Matta, Epidemiologist attended the
workshop.
52. A guest lecture on ‘Electronic Nicotine Delivery System (ENDS)
as a substitute to conventional cigarette: an evidence based
Audit was organised on 30th September 2016 in community
Medicine, Department of MAMC. Dr. K. K. Chopra, Director
and Dr. Shanker Matta, Epidemiologist attended the lecture.
Dr. K. K. Chopra, Director also chaired the scientific session.
53. A RNTCP sensitization programme was organised on 3rd
October, 2016 for first year B.Sc students of Holy Family
Nursing College. 56 students participated in the programme.
They were briefed about diagnosis and management of TB
under RNTCP and how to prevent TB in community. Dr.
Shanker Matta (Epidemiologist) and Mrs. Gurpreet Kaur (PHN)
were facilitators.
54. A meeting of national level expert committee for diagnosis and
treatment of TB was organised in Nirman Bhawan on 6th October
2016. Dr. K.K. Chopra, Director participated in the meeting as
one of the national experts. Shorter regimen for MDR TB and
new strategic plan 2017-2023 was discussed in the meeting.
55. Financial management workshop for District TB Officers and
District Accounts Managers under Delhi RNTCP was held on
7th October 2016, in STDC Delhi.
56. Ethical Committee meeting of World Lung Foundation – South
Asia was held on 8th October 2016. Dr. K.K Chopra, Director
attended the meeting as its member. Two research projects
related to tobacco cessation were discussed and approved.
40
57. 67th TB seal campaign of NCT of Delhi was held in LG House on
14TH October 2016. Dr. K.K Chopra, Director attended the
campaign.
58. A CME on TB Notification was organised by The Union and
East Delhi Medical Association on 15th October 2016. Dr. K.K
Chopra, Director attended the CME and delivered a lecture on
“Standards of TB control in India”.
59. Two days consultative workshop on "National Strategic Plan for
TB Control in India (2017-23)" was held in New Delhi on 18th
and 19th October 2016. Dr. K.K Chopra, Director attended the
meeting as an expert and delivered a lecture on “Challenge of
RNTCP implementation – State perspective” during the
workshop.
60. A training programme for 27 students of (Lady Health Visitors)
from Lady Reading Health School was conducted on RNTCP-
TB on 2nd November 2016.
61. Hands on training of Project ECHO was conducted in New Delhi
from 8th to 10th November 2016. Dr. K.K. Chopra, Director
attended the training with representatives from DRTB Centres
of six sites of India and State TB Department. Training was
conducted by facilitators from New Maxico University.
62. A trial run of project ECHO was conducted at NITRD on 11th
November 2016. All DTOs of Delhi state attended the trial run.
They were sensitized about the project ECHO and weekly clinics
to be conducted.
63. One day workshop for “Stake holder for NABL accreditation of
selected 15 laboratories” was organised on 13th November 2016
in Pune. The workshop was organised by Central TB Division
and FIND. STOs and STDC Directors and Microbiologists of
selected 15 laboratories participated in the workshop. Steps
41
for process of NABL accreditations were discussed and timeline
for activities was drawn. Dr. K.K. Chopra, Director and Dr. M.
Hanif, Microbiologist participated in the workshop.
64. Delhi State Operational Research Committee meeting was held
on 15th November 2016 in NDTB Centre. Faculty of the Centre
participated in the meeting. Dr. K.K. Chopra, Director
presented status of three OR projects being undertaken at
NDTB Centre. In all 22 OR proposals and thesis protocols
were presented and discussed.
65. Secretary Health (Government of NCT of Delhi) conducted a
review of various programmes of Delhi state on 21st November
2016. Dr. K.K. Chopra, Director presented the status of RNTCP
in Delhi state during the review meeting. Various activities of
RNTCP were discussed including challenge in financial
management.
66. A meeting of NSP sub group 3 (Treatment Gp) was held on 25th
November 2016 in NDTB Centre. Representatives from WHO,
Central TB Division and faculty of NDTB Centre participated in
finalising the draft of treatment as part of NSP strategy.
67. On the occasion of World AIDS DAY, a health mela was organised
in Jawaharlal Nehru Stadium on 1st December 2016. Central
TB Division put up a stall in the mela. NDTB Centre staff
participated and put up demonstration of rapid TB Diagnostic
– Gene expert test at the health mela TB stall.
68. State level review meeting for Bedaquiline implementation was
held in Delhi on 8th December 2016. Dr. K.K. Chopra, Director
coordinated the meeting. Nodal officers of DRTB sites presented
the status of cases put on Badequiline containing regimen.
Attached DST laboratories presented the data of the second
line DST conducted on MDR cases to decide about their
42
eligibility for Bedaquiline. Representatives from Central TB
Division, WHO and The Union attended the review meet.
69. Review meeting of “SMS for Sure” project was held in NDTB
Centre on 9th December 2016. DOT Providers of selected chest
clinics participated in the review meet. The data of patients
enrolled in the project was discussed.
70. In MDR-ECHO clinic (which is held every Wednesday) on 14th
December 2016, Dr. K.K. Chopra, Director delivered a Dietetics
on “Challenges and constrains in Management of MDR TB”.
This was in form of video-conferencing with District TB Officers
of Delhi state.
71. Dr. Shanker Matta, Epidemiologist participated in three days
training programme on “Logistics Management” from 14th to
16th December 2016 held in NTI, Bangalore. This was conducted
by Central TB Division and emphasis was on systematically
managing the distribution CBNAAT cartridges in the
laboratories.
72. NATCON 2016 was held from 16th to 18th December 2016 at
PGI Chandigarh. Dr. K.K. Chopra, Director and Dr. M. Hanif,
Microbiologist attended the NATCON. Dr. Chopra delivered a
lecture on “Standards of TB Care in India” during CTD session
of Eradicating TB by 2050. Five research papers prepared by
NDTB Centre were selected for poster presentation during the
NATCON.
73. A CME programme was organised in the auditorium of Lady
Hardinge Medical College by Delhi State RNTCP team on 21st
December 2016. Dr. K.K. Chopra, Director delivered a lecture
on “Standards of TB Care in India” during the CME.
74. A meeting to finalise the strategy for conducting “Active Case
Finding – TB Services to door steps” was held in STDC on 23rd
43
December 2016. Representatives from State TB Cell and WHO
participated in the meeting and discussed the strategies for
conducting the project in Delhi state.
75. A one day sensitization programme for active case finding
survey was conducted on STDC on 26th December 2016. District
TB Officers of all the districts attended the programme. Steps
of conducting and monitoring the survey were discussed. Their
feedback on smoothly conducting the survey was also taken
up and incorporated in the strategy.
76. ECHO MDR clinic was held on 4th January 2017. Didactic for
the clinic was on “Nationwide special TB campaign for Active
Case Finding” by Dr. K.K. Chopra, Director. This was followed
by clinical case discussion by DTO, Gulabi Bagh Chest Clinic.
77. A meeting to review the progress of Paediatric CBNAAT Project
was held on 6th January 2017 in STDC. Representatives of
State TB Office, FIND and Dr. M Hanif, Microbiologist, NDTB
Centre participated in the meeting. It was decided to wind up
the project by March 2017.
78. A meeting of Treatment Group (National Strategic Plan 2017-
2023) was held on 6th January 2017 in STDC. Representatives
from NDTB Centre, WHO and Central TB Division participated
and discussed to finalise the treatment group write up.
79. A national expert committee meeting was held on 18th January
2017 with DGHS, Ministry of Health & Family Welfare,
Government of India regarding expansion of Bedaquiline with
CAP conditions to other parts of the country. Dr. K.K. Chopra,
Director attended the meeting. It was decided to identify at
least 30 sites where facilities of second line DST are available
and bedaquiline can be introduced in pre-XDR and XDR cases
of these sites.
44
80. Regarding nationwide Active Case Finding Campaign, a meeting
of District TB Officers of Delhi state with NGO partners was
held in STDC on 19th January 2017. Constitution of field teams,
their work instruction and schedule for supervision of this
activity was discussed and finalised.
81. Weekly MDR-ECHO Clinic was held on 25th January 2017. This
time the clinic was conducted from STDC for monitoring of
Active Case Finding Survey. All the DTOs, NITRD Delhi, NTI
Bangalore and STO of Tamilnadu were connected online. Field
visit experiences of State Supervisors and DTOs were shared.
Issues in the field activity were also discussed and resolved
during the session. Similar sessions were also conducted on
1st and 8th February 2017.
82. Delhi TB Association organised a Community Volunteers
Training Programme – “Health: a Social Movement” on 27th
January 2017. Dr. K.K. Chopra, Director delivered a lecture
on ‘Hazards of irregular treatment and prevention of MDR TB”.
About 70 volunteers attended the session.
83. A CME was organised on 27th January 2017 in Rohini for
members of Indian Association of Paediatricians (North Delhi
Branch). They were briefed about CBNAAT paediatric project
and guidelines of paediatric TB diagnosis and management.
Dr. K.K. Chopra, Director attended the CME and participated
in panel discussion.
84. Weekly ECHO clinic was conducted from STDC on 1st February
2017. 38 speakers and 140 persons attended the clinic.
Activities of Active Case Finding Campaign being conducted in
Delhi State was reviewed. State Supervisors shared their
experiences and discussed various issues faced in the field.
85. Weekly ECHO clinic on 8th February, 2017 was conducted from
STDC hub. This was last session for review of Active Case
45
Finding activities in Delhi State. 33 speakers and 119
participants attended the session. Final results of the two weeks
activity were reviewed in the session and DTOs suggested some
innovation to be included in second phase to be conducted in
July, 2017.
86. Delhi State Task Force meeting was held on 10th February,
2017 in AIIMS. Faculty of NDTB Centre participated in the
meeting as its members. Dr. Chopra, Director delivered a
lecture on ‘Standards of TB care in India”.
87. A CME was organised in Jaipur Golden Hospital, Rohini, New
Delhi on 11th February, 2017. The Doctors of various hospital
attended the CME. Dr. K.K. Chopra, Director delivered a lecture
on Clinical aspects and TB and its standard management.
88. One day sensitization for members of NGO VIHAN working in
the community was held on 13th February, 2017. 25 members
attended the programme. They were briefed about daily Anti
TB treatment for PLHIV as per TB-HIV Co-ordination programme.
Similar sensitization programme was held on 14th February,
2017 in which 20 participants attended the session.
89. Dr. Hanif (Microbiologist) attended an International Symposium
on Genomis of Mycobacterium Tuberculosis which was held at
NIRT, Chennai from 17th February, 2017 to 18th February, 2017.
During the symposium, many eminent scientists from CDC,
Atlanta, USA, University of Cambridge, U.K. Medical Research
Centre, U.K. and Deptt, of Biotechnology, Government of India
gave talks about whole genone sequencing and its application
in TB and MDR TB diagnosis. Each session had power point
presentations and panel discussions by distinguished scientists.
90. A workshop to discuss modalities to conduct Active TB Case
finding in red light area of GB Road, New Delhi was held on
10th Feb, 2017 in NDTB Centre. Representatives from State TB
46
Cell, Delhi State AIDS Control Society and VIHAN, NGO
attended the workshop. During the workshop, the work
instructions were finalised as how to conduct the active case
finding campaign. It was decided to start the campaign from
27th February, 2017 till World TB Day.
91. A CME for faculty and resident doctors of BJRM Hospital was
conducted on 23rd Feb, 2017. Dr. K.K.Chopra, Director
delivered a lecture on ‘Recent Initiatives in Diagnosis and
Management of TB under RNTCP’.
92. A sensitization meeting with stake holders for Active Case
Finding among commercial sex workers and their family
members was conducted on 23rd February, 2017 in STDC.
Representatives from Chest Clinics – Pili Kothi and Lok Nayak
Hospital, VIHAN NGO, outreach workers and Peer group
working in GB Road area attended the sensitization. Process
of Active case Finding campaign was briefed to them.
93. The two days consultative meetings to finalize National Strategic
Plan (2017-23) was held in Delhi on 28th February, 2017 and
1st March 2017 by Central TB Division and WHO. Dr.
K.K.Chopra, Director participated as a member of Treatment
Group. Representatives from CTD, WHO, NGO, Partners, Medical
Colleges, National Institutes and experts from various fields
attended the meeting.
94. Ethical Committee meeting of NITRD New Delhi was held on
2nd March 2017. Dr. K.K. Chopra, Director attended the meeting
as one of its member. During the meeting, total eight projects
were discussed and some changes were suggested for
incorporation.
95. A CME for doctors and staff of Urban Training Health Centre,
Najafgarh was conducted on 10th March 2017. About 80 doctors
47
and para medical staff attended the CME. Dr. K.K. Chopra,
Director delivered a lecture on “Newer Diagnostics and Standards
of TB Care in India”.
96. Mid-term review of Active Case Finding Campaign was held on
14th March 2017 at New Delhi TB Centre. The representatives
from Delhi State RNTCP team, VIHAN NGO and DSAC society
attended the review meeting. Dr. K.K. Chopra, Director
presented the findings of the campaign till date. The issue
faced in the field activities and outcome of the campaign was
discussed.
97. Weekly MDR ECHO clinic was held on 15th March 2017 in NITRD.
Didactic was delivered for the clinic by Dr. M. Hanif,
Microbiologist on “ EQA issues under the National Programmein Delhi State”.
98. Delhi State PMDT review meeting was held on 16th March 2017
in STDC Delhi. Nodal officers of culture DST labs and DRTB
centres presented their reports of the quarter. Various issues
related to labs and especially bedaqualine intake were discussed.
99. A CME was organised by R.K. Mission Chest Clinic on 20th
March 2017 as a part of World TB Day celebration. During the
CME, Dr.K.K.Chopra, Director delivered a lecture on “Standards
of TB Care in India (STCI) & Newer Diagnostics”.
100. A CME was organised by RBIPMT Chest Clinic on 21st March
2017 as a part of World TB Day celebration. During the CME,
Dr.K.K.Chopra, Director delivered a lecture on “Standards of
TB Care in India (STCI)”.
101. A “World TB day symposium” was organised by AIIMS on 22nd
March 2017. During the symposium Dr. K.K. Chopra chaired
a session on “Challenges of TB control”.
48
102. A CME on “Newer Initiatives in Revised National Tuberculosis
Control Program in India” was organised by Department of
Community Medicine, Maulana Azad Medical College in
association with State TB Cell, New Delhi on 23rd March 2017.During the CME, Dr.K.K.Chopra, Director delivered a lecture
on “Current perspectives in management of TB”.
103. A seminar on TB was organised by All India Institute of Medical
Sciences (Clinical Microbiology Department) on 24th March
2017. During the CME, Dr.K.K.Chopra, Director chaired a
session on “TB control activities at national level”.
104. Delhi TB Association has organised Seminar on ”TB Controland Prevention with special reference to participation of Delhi
University (DU) Students to End TB” as part of this year WorldTB Day Celebrations on 30 th March 2017. During theprogramme, Dr. K.K. Chopra delivered a lecture “Challenges of
TB control”.
105. A press conference was organised in Press Club of India on 31st
March 2017. This was regarding dissemination of results of
Active Case Finding among female sex workers in GB Road
area. Dr. K.K. Chopra, Director briefed about the results of
Active Case Finding Campaign.
49
1. The Annual General Meeting of TB Association of India was held
on 4th April 2016. Various staff members attended the said
meeting.
2. The Central Committee Meeting of TB Association of India was
held on 4th April 2016. Dr. K.K. Chopra, Director attended the
said meeting as its member.
3. A meeting to prepare Bye-Laws of NDTB Centre was held on 3rd
May 2016 in NITRD Delhi under chairmanship of Dr. Rohit Sarin
(Director-NITRD). Dr. Devesh Gupta (Addl. DDG-TB), Mr. Ahluwalia
(Secretary General-TAI) and Director, NDTB Centre were members
of the Committee. The draft Bye-Laws and Recruitment Rules of
Group B and C posts were discussed. It was decided to make
some minor corrections and circulate among its members for
approval and to be put up to the Chairman, Managing Committee,
NDTB Centre.
4. Final meeting of Bye-Laws Committee of New Delhi TB Centre
was held on 4th June, 2016 in NITRD. It was decided to put up the
final draft to Managing Committee of NDTB Centre.
5. Meeting of Managing Committee of New Delhi TB Centre was held
on 18th October 2016 in conference room of NDTB Centre under
the chairmanship of Dr. L.S. Chauhan. Various issues related to
general administration were discussed. The annual report and
budget estimates were approved.
6. A programme to distribute two wheelers to supervisory staff of
RNTCP was organised on 21st November 2016 by Delhi state RNTCP
department. The Health Minister of Government of NCT of Delhi
was the Chief Guest. Dr. K.K. Chopra, Director presented the
brief on activities of RNTCP in Delhi state during the function.
7. A meeting of Delhi TB Association was held on 25th January 2017
to discuss the issues regarding maintenance of their building.
Dr. K.K. Chopra, Director participated as one of its member.
8. Central Committee meeting of TB Association of India was held
on 27th March 2017. Dr.K.K.Chopra, Director attended the meeting
as its member. Staff members of NDTB Centre also attended the
Annual General Meeting of TAI on the same day.
MEETINGS
50
CLINICAL SECTION
OPD Services
The Centre caters to patients of TB and Respiratory diseases referred
for diagnosis and opinion from different departments of LN Hospital,
GB Pant Hospital and Guru Nanak Eye Centre. Many private
practitioners and doctors of various hospitals of Delhi and neighbouring
states also refer patients for expert opinion on diagnosis and treatment.
Apart from seeing patients from our designated area, we are increasingly
getting many complicated cases from all over Delhi and outside Delhi.
Most of these patients have been under management from a variety of
doctors (both private and public sector) for months together and are
still searching for a valuable opinion. During the year, 2016-17 the
total OPD attendance at the Centre was 10157 and revisits were 9895.
The total attendance in the clinic was 20052. The table shows month-
wise distribution of OPD attendance
Total OPD Attendance during the year (April 2016 to March 2017)
S.No. Month Male Female Total
1. April’16 655 811 1466
2. May’16 767 914 1681
3. June’16 854 1197 2051
4. July’16 714 974 1688
5. August’16 697 1062 1759
6. September’16 700 920 1620
7. October’16 625 864 1489
8. November’16 610 858 1468
9. December’16 616 921 1537
10. January,17 665 1068 1733
11. February’17 623 1153 1776
12. March’17 686 1098 1784
Total 8212 11840 20052
51
TB and Diabetic screening
As a routine all registered patients are tested for Blood Sugar (Fasting)
to detect Diabetes Mellitus before starting treatment. In all a total of
66 patients were put on DOTS during the year 2016-2017. Four
patients were found diabetic, they were referred to Diabetes clinic for
its management.
COAD Clinic
Other than TB patients, a bulk of our OPD attendance comprises of
COAD patients. As a standard protocol, we have a very well checked
out plan of management for them wherein their disease is well
controlled requiring no admissions/emergency room visits for acute
exacerbations. During the year, 562 patients were screened out of
which 310 were male and rest 252 were female which shows that
satisfaction level and acceptance to treatment of these COAD patients
is very high.
Tobacco and cessation clinic
Since January 2013, the tobacco cessation clinic is being run by our
staff where patients are made to understand the harmful effects of
smoking. Not only that, counseling sessions are being arranged for
them and we try to motivate them for leaving these habits. By the
end of March, 2017, 104 patients have been registered and then are
attending the clinic regularly. 43 of them have completely given up
smoking and are feeling better and healthy, 35 have reduced and
their habit of smoking and alcohol.
Radiological Examination
Table below gives month-wise distribution of radiological examination
done.
52
X-ray examinations done during the year
(April 2016 to March 2017)
S.No. Month No. of New Cases Old Cases
X-ray done
1. April’16 102 85 17
2. May’16 145 122 23
3. June’16 106 82 24
4. July’16 132 110 22
5. August’16 155 119 36
6. September’16 122 99 23
7. October’16 111 83 28
8. November’16 131 102 29
9. December’16 105 80 25
10. January,17 117 84 33
11. February’17 133 99 34
12. March’17 202 158 44
Total 1561 1223 338
DOTS Centre
One DOT cum Microcopy Centre is situated in the complex of the
Centre. Here free diagnosis and treatment is provided to patients
who belong to the area according to RNTCP guidelines. The doctors
of the Centre screen the TB suspects, advise investigations and
categorize the patients suffering from TB for treatment. Patients of
the DOT centre also visit our OPD for management of side effects due
to intake of Anti-TB drugs.
Presently 28 patients are enrolled at DOTS Centre situated at NDTB
Centre and are taking regular treatment. The details are given below:-
Category No. of Patient
Cat I 22
Cat II 3
Pediatric cases 3
Total 28
53
EPIDEMILOGICAL SECTION
Epidemiology section of New Delhi Tuberculosis Centre is involved in
various activities. Some of the key activities being undertaken are
screening of staff from various organizations, like National Zoological
Park, hotels, embassies, involvement in various projects, monitoring
and supervision of various chest clinics of Delhi, involvement in TB
related projects etc.
(A) Active Case Finding Campaign among high risk groups
One of the activity undertaken by the Epidemiology Department of
New Delhi Tuberculosis Centre was the supervision of Active case
finding campaign of TB cases in January 2017. Active case finding
campaign through house to house survey for search of TB symptomatic
was proposed by Central TB Division in January 2017. This was a
national level activity which is being implemented throughout the
country. This was a 2 weeks activity which is to be conducted thrice
in this year. A team of 4 persons which includes RNTCP DOT provider,
ASHA worker and NGO representative conducted house to house
survey. With the guidance of DTO, the team was to identify high risk
groups (slum population, prisons, construction sites etc), to look for
TB symptomatic. Before the survey all DTOs of Delhi state were trained
for this activity. They were also requested to do mapping of their
respective area specifically targeting slum population, construction
sites, prisons, and night shelters for this activity. A format was designed
for this survey. The team visiting the high risk groups had to note
details like name of the resident, age, sex address. A question
regarding symptoms of TB was asked, if the answer was no; the team
had to mark the house with chalk and move on to the next house. If
the answer was yes (that is any person in the family had cough for 2
or more weeks duration/fever etc) an on the spot sputum sample was
collected by the team and the patient is convinced to come to the
centre to provide second sputum sample. Mobile numbers of
symptomatic patients are noted so that they can be followed up later.
Supervision of this activity was conducted by staff of State TB cell,
54
WHO consultant and NDTB faculty. At the end of the day the staff
had to submit the filled formats. Another important activity was the
entry of the identified TB cases on the Nikshay portal which has to
be entered by the data entry operator of the respective chest clinics.
For the ground level staff conducting house to house survey this was
an incentivized activity. For each positive case found and initiated on
treatment the government has proposed an incentive amount of Rs
500/- for the team involved in the survey.
During the ECHO based meet, various problems were highlighted by
DTO’s as well as the ground level staff, which were encountered during
the campaign. Problems like refusal to provide second sputum sample,
difficult areas to be covered, pockets with drug addicts/dangerous
areas etc were encountered as well as highlighted .Reason behind
highlighting these problems was to be prepared for the next ACF
activity which is to be conducted in the month of July and December
2017. During these months, campaign activity would be conducted
on similar lines taking into consideration the problems encountered
in the present survey
Results of the activity:
· Total number of persons screened : 189633
· Number of sputum suspects from whom : 2817
samples examined
· Number of TB patients diagnosed : 242
(B) ACF activity for TB cases in GB road area
Another activity undertaken by Epidemiology department, New Delhi
Tuberculosis Centre was Active case finding campaign through house
to house survey for search of TB symptomatic. This was a national
level activity which is being implemented throughout the country.
This was a 2 weeks activity which is to be conducted thrice in this
year. It was proposed that this activity should also be conducted in
the GB road area, which is also a red light area. An NGO by the name
of VIHAAN working in the field of HIV AIDS was involved. Outreach
55
workers working with the AIDS programme were trained to identify
TB cases through house to house survey. Ground level staff from Pili
kothi chest clinic and LNJP chest clinic also attended the training.
Idea behind this was to help the team initiate patients treatment.
Staff from VIHAAN as well as outreach workers including peers
working in GB road area were trained to identify chest symptomatic
.This was a one day training programme conducted on 23rd February
2017. 4 teams were identified to conduct the survey. Each team
comprised of a Peer, Vihaan NGO representative and 2 outreach
workers. If a patient is found with TB symptoms the outreach worker
would note details of the patient and his sputum would be examined
at NDTB. The team has to ensure that sputum sample is collected
and they bring the patient to NDTB for x-ray as well as second sample.
An incentive of Rs 50 per sample is being given to the outreach worker
for bringing the patient. EP samples are being sent to LNJP for culture.
This was a 20 day long activity. Data compilation, analysis, monitoring
and supervision was undertaken by staff of NDTB
Results of the activity:
Total population screened : 2517
Total number of buildings covered : 22
Total number of rooms covered : 95
Total number of sex worker population screened : 1875
· Number of sputum suspects examined : 57
· Number of TB patients diagnosed : 02
56
PUBLIC HEALTH SECTION
Public Health Section is one of the department of New Delhi
Tuberculosis Centre. This department is involved in various activities
including public health interventions. Following activities are
undertaken with the help of specialized staff which includes an
Epidemiologist, Public Health Nurse, Medical Social Worker and Multi
Purpose Health Worker:
Health talk
Health talk is one of the major activity through which information is
disseminated amongst masses. This is the simplest method to
communicate any message from one person to another. New Delhi
TB Centre is conducting in-house health talk on daily basis in its
main OPD hall where around 150-200 patients and their relatives
visit every day.
TB and film shows
By using audio-visual aids we try to generate awareness amongst our
patients and their relatives. We have various documentaries made
on TB which are being displayed every day in our main OPD hall. We
distribute print material to our visitors to recapture our message given
by us through word of mouth.
TB Supervisor course
During this year 4 batches took 3 months training of TB Supervisor
Course. The total strength of students was 51. Broadly our focus
was on following aspects:
· Tuberculosis
· RNTCP
· Modules used in RNTCP
· General aspects of health care
57
Mantoux test
Mantoux test is done at the NDTB Centre. Apart from being referred
from the OPD of NDTB Centre the patients are also referred from
various government hospitals as well as those taking treatment by
private practitioners for Mantoux Screening.
During the period April 2016 to March 2017, 8425 mantoux test
were done at the NDTB Centre. Out of these, results of 7451 patients
were available. Month-wise Mantoux screening undertaken is as
follows:
Month Total test Test read Reactors Non Reactors
(2016-17) (>10mm) (<10mm)
April’16 619 549 279 270
May’16 719 634 281 353
June’16 895 787 400 387
July’16 741 649 312 337
August’16 723 635 325 310
September’16 657 590 242 348
October’16 667 580 237 343
November’16 597 509 215 294
December’16 639 572 236 336
January,17 753 659 271 388
February’17 767 691 291 400
March’17 648 596 263 333
Total 8425 7451 3352 4099
Anti TB week celebration
To mark the occasion i.e. World TB Day (24th March) we organise
different community based programmes with various NGOs working
58
with us. This year also, our organisation conducted different
programmes as per below mentioned schedule
Date & Time Programme Methodology Participants
2.4.2017
10.00 AM Inauguration All Participants Bacho Ka Ghar
of Anti TB to write poem SPYM (Male)
Week Poem on TB SPYM (Female)
Competition + Student TB
Supervisory
3.4.2017 Painting Painting Bacho Ka Ghar
10.00 AM Competition competition SPYM (Male)
covering various SPYM (Female)
aspects of
Tuberculosis
4.4.2017 Slogan and All participants Bacho Ka Ghar
10.00 AM completion will write slogan SPYM (Male)
speech and present SPYM (Female)
speech on TB
7.4.2017 Quiz All participants Bacho Ka Ghar
10.00 AM competition to NGO + TB SPYM (Male)
Supervisor SPYM (Female)
students to + Student TB
answer questions Supervisory
regarding
Tuberculosis
24.4.2017 Function Prize Bacho Ka Ghar
11.00 AM distribution SPYM (Male)
SPYM (Female)
+ Student TB
Supervisory
All the winners of competition were awarded prizes. This year theme
is “Unite to End TB”. This event is covered by local news paper named
‘SAHAFAT’ Delhi.
59
Community meeting and health talk
31st May ‘World No Tobacco day’ was celebrated All visitors
2016 where a health talk was delivered of OPD
highlighting the harmful effects of
smoking and other drugs.
5th June World Environment Day was celebrated Staff
2016 at our Centre. The staff was requested NDTBC
to voluntarily donate a plant for centre.
1st July An interaction session was organized by Doctors
2016 the Centre where all the doctors and other and other
staff attended the session. The new drug staff
regimen and treatment updates were
explained to staff by our doctors on
‘DoctorsDay’.
11th July A community meeting was organized at All
2016 Mata Sundari Road Juggi Cluster. The residents
local community was sensitized about TB
and its importance.
12th A quiz competition was organized for TBHV Students
August students on youth rights to generate TBHV &
2016 awareness about youth programmes. staff
20th 76th Annual day was celebrated on All staff
November 20th November 2016 where CMEs for
2016 doctors was organized. The staff was
invited for lunch. Various sports
competitions were organized by the
Centre to mark the occasion.
1st A health talk was organized at Staff and
December SPYM girls where inmates and staff inmates of
2016 were sensitized about AIDS and HIV. SPYM
female
24th March Anti TB Week, World TB Day Celebration
2017
60
TB Screening:
NDTB Centre is not only catering to TB patients but also tries to
reach community through its community based programmes. There
are three organizations namely, SPYM Girls (Street and Working
Children), SPYM Boys and Bachon Ka Ghar Orphanage working in
old Delhi area. All children of these organizations were screened for
TB. This year 103 children were examined.
During the month of February / March 2017, Active case detection
activity was conducted in collaboration with VIHAN. VIHAN is an
organisation working for HIV positive patients. They try to detect the
positive cases from different brothel houses. Recently with the help
of outreach workers we have screened 56 TB suspects, out of which 3
were put on treatment. They are taking medicines from Pili Kothi
Chest Clinic.
S. Gender X-ray Sputum CBNAAT Put on
No. examination examination treatment
-ve +ve -ve +ve - -
1. Male 16 - 14 - - -
2. Female 35 5 33 1 5 3
51 5 47 1 5 3
5 patients underwent CBNAAT after X-ray examination.
In the month of March 2017, we have adopted three communities
with the objective of making them TB free community. Aim was to
find TB symptomatic in the community and if diagnosed with TB, to
initiate treatment. The communities adopted and made TB free are:
· 100 quarter behind Ferozshah Kotla Stadium
· Kotla Road Juggi Cluster near Bal Bhawan
· Juggi Cluster, Mata Sundari Road
61
The results of TB screening activity conducted in these areas are
given below in the table:-
Results of TB screening activity
S. Name of the Total Total Number of Put on
No. community house population symptomatic treatment
average found
population
/house
1. *100 quarter 171 855 5 1
2. **Kotla Road 125 250 13 1
Juggi
3. ***Mata 190 950 13 -
Sundari Road
Total 486 2055 31 2
* 100 quarters consists of 171 houses out of which 147 houses
were covered by our health workers, 24 houses were locked. Only
five symptomatic were found who were further screened at our Centre.
1 patient was diagnosed with TB and he was put on treatment from
our DOT Centre under Cat I sputum negative regime.
** In Kotla Road Jhuggi, there are total 125 jhuggies out of which
25 jhuggies are in duplicate means one person having two jhuggies
and rest of 50% i.e. 50 juggies found were locked. Only 50 jhuggies
were covered and the population covered was 250. 13 symptomatic
were screened. Out of which 1 was diagnosed with TB and put on
treatment.
*** The third community adopted is Mata Sundari Road, Jhuggi
Cluster, New Delhi. Where approximately 300 plus jhuggis were
found and 190 jhuggis were surveyed by our health worker. People
residing there are engaged in different factories of car spare parts
situated in the community itself. Most of them are illiterate and
alcoholic. In all 13 symptomatics were found.
62
MYCOBACTERIAL LABORATORY
The laboratory is certified as Intermediate Reference Laboratory by
Central TB Division, Min. of Health & Family Welfare, Government of
India for Line Probe Assay, solid and liquid culture and DST. Samples
are received from 17 chest clinics of Delhi for diagnosis and follow-
up under PMDT activities. Base line drug susceptibility testing for
second line drugs are being carried out in routine using MGIT 96
liquid culture system. This laboratory is being selected as one of the
site to conduct Line Probe Assay for second line drugs.
63
Annual Annexure M for the year, 2016 (District Wise)
Name of Nos. of Nos. of Nos. of TB Nos. of Nos. of Nos. of Total Total Total
DMC TB TB suspects TB suspects follow-up follow-up nos. of nos. of nos. of
suspects suspects undergoing found to patients patients slides negative positive
examined found repeat be positive examined found examined slides slides
for to be diagnostic on repeat to be examined examined
diagnosis positive examination diagnostic positive
examination
BJRM 6649 679 86 5 1938 68 15355 1411 13944
GTBH 10505 1338 55 4 2173 193 23299 2849 20450
HEDGEWAR 4566 610 43 5 826 82 10027 1322 8705
KCC 6514 771 18 2 2909 141 15966 2526 13440
LNH 9676 796 30 1 818 67 18458 1647 16811
JHANDEWALAN 2520 425 18 2 1277 111 6307 950 5357
SPM MARG 4463 503 26 3 1014 72 9925 1139 8786
SHAHDARA 5303 782 244 2 2057 206 12647 1724 10923
PATPARGANJ 13999 1954 317 3 4556 286 33019 4088 28931
RKM 2673 303 146 24 764 44 6370 645 5725
NEHRU NAGAR 13019 1708 65 13 6170 508 35143 4148 30995
64
MOTI NAGAR 11491 1601 197 29 3659 181 25971 3132 22839
RTRM 8948 934 58 7 2134 212 20158 2053 18105
NARELA 6936 1034 16 0 2518 235 16450 2235 14215
K. NAGAR 6472 1067 19 3 3397 296 16258 2387 13871
NDMC 21837 2469 41 1 3127 231 46688 5227 41461
BSA 6947 951 116 3 2341 157 16470 1937 14533
DDUH 10805 1379 129 21 3622 246 25193 2980 22213
GULABI BAGH 3571 292 89 3 694 52 7698 591 7107
LRS 7710 850 30 1 2151 137 17602 2390 15212
SGMH 8016 1091 25 1 2855 108 18686 2142 16544
SHASTRI PARK 6955 1068 90 11 2841 268 16908 2368 14540
DESHRAJ 6109 759 70 14 1857 170 12374 1694 10680
MALVIYA NAGAR 5137 841 8 2 2976 421 13217 2096 11121
BIJWASAN 5363 532 38 18 2622 279 14320 1452 12868
Total 196184 24737 1974 178 61296 4771 454509 55133 399376
During the year, a total of 1,96,184 TB suspects were examined for diagnosis in all 25 chest clinics
of Delhi state out of which 24,737 were found positive. 4,54,509 slides were examined as per data
received from TB laboratory abstract. Out of these 55,133 slides were found positive. A total of
3,99,376 slides were found negative.
65
On-site Evaluation visit and Panel Testing
An IRL team comprising of Microbiologist, one Medical officer and
one Laboratory Technician visits each chest clinic at least once a year
to DTCs for on-site evaluation. During the visit, randomly selected
DMCs are also covered for evaluation.
Recommendations of the annual supervisory visits to the districts by
the IRL have focused on operational and technical problems of the
laboratories including availability of staff, infrastructure, regular
supply of consumables and training. During the visit, panel testing
for STLs was conducted. DMCs reporting false positive or negative
errors in RBRC were also visited by the IRL team.
List of DTCs visited by IRL Team for OSE
S. No. Name of Chest Clinic Date of visit
1 BJ RM Chest Clinic 03/03/2016
2 Patparganj Chest Clinic 09/03/2016
3 GTB Chest Clinic 15/02/2016
4 R.K. Mission Chest Clinic 11/04/2016
5 CH. Desraj chest clinic 30/05/2016
6 S.Park Chest Clinic 13/07/2016
7 KCC Chest Clinic 14/07/2016
8 BSA Chest Clinic 27/07/2016
9 Narela Chest Clinic 26/07/2016
10 Karawal Nagar Chest clinic 29/07/2016
11 LNH Chest Clinic 04/08/2016
12 SGMH Chest Clinic 09/08/2016
13 SPM Chest Clinic 11/08/2016
14 Gulabi Bagh Chest Clinic 16/08/2016
15 Shahdara Chest Clinic 19/08/2016
66
PMDT activities carried out during the year April 2016 – March 2017
(Specimens processed on culture or DST)
Quarter Diagnostic Follow-up LPA DST H+R H+R Only Only
2016- Sputum Specimens Done Sens Res H R
2017 Specimens inoculated Res Res
inoculated
2Qr 2016 1848 1745 1350 1030 143 122 22
3Qr 2016 1747 1759 1318 1023 168 115 22
4Qr 2016 1359 1693 1354 1078 145 78 23
1Qr 2017 1597 1867 1044 847 111 73 13
TOTAL 6551 7064 5066 3978 567 388 80
The table provide the details of laboratory tests done under PMDT
activities during the year 2016-17. A total of 6551 sputum specimens
were processed out of which 567 cases turned out to be MDR-TB and
80 Rif mono resistant.
16 Jhandewalan Chest Clinic 07/09/2016
17 Malviya Nagar Chest Clinic 20/09/2016
18 Bijwasan Chest Clinic 14/09/2016
19 NITRD Chest Clinic 22/12/2016
20 RTRM Chest Clinic 27/12/2016
21 Hedgewar Chest Clinic 07/11/2016
Programmatic Management of Drug Resistant Tuberculosis (PMDT)
Activities
The laboratory got certification by CTD for Line Probe Assay, solid
and liquid culture and DST. Currently sputum samples received from
17 chest clinics for diagnosis and follow-up under PMDT activities in
Delhi.
67
Laboratory examinations carried out for cases referred by
Private Practitioners during the year 2016 - 2017
Month Laboratory examinations
Smear Culture Drug
examination (Solid) Susceptibility
testing by
solid culture
April 242 242 28
May 251 251 34
June 323 323 20
July 257 257 22
August 202 202 20
September 180 180 00
October 149 149 12
November 112 112 20
December 124 124 13
January 116 116 16
February 160 160 12
March 137 137 18
TOTAL 2253 2253 215
Table depicts data of month wise laboratory examinations carried out
during the year 2016-17. A total of 2253 smears were examined,
equal number of cultures were done and 215 drug susceptibility
testing were performed.
68
TRAINING AND MONITORING SECTION
The institute is actively involved in the training of various
medical and paramedical personnel who visit from Delhi and other
states of our country, in implementation of strategies under Revised
National Tuberculosis Control Programme (RNTCP). Several training
programmes have already been conducted by the institute for doctors,
Medical Students from Mulana Azad Medical College & Patel Chest
and paramedical personnel (Dot Provider, STS, DEO, Lab Tech., Sr.
Lab Tech., Treatment organizers and Sr. Treatment supervisors).
Training is also imparted to the nursing students from Ahilaya Bai
College of Nursing, Lady Reading Health School, Safdurjung Hospital,
Rajkumari Amrit Kaur College of Nursing. The trainings done during
the year are given as under:
TRAINING ACTIVITIES
In all during the year, 115 days of training sessions were conducted
wherein 2439 personnel were trained regarding various aspects of
the RNTCP which includes 90 sessions. Topics like infection control
for health workers, roles and responsibilities of nursing personnel
for care of TB patients and prevention against tuberculosis were also
discussed in detail. The details of training are given below:
Training Programmes conducted from 01st April 16 to 31st March 17
Details of Trainings/ Sensitizations held at New Delhi TB Centre (STDC)
01st April 2016 to 31st March 2017
S. Detail of Training Period Days No. of
No. Participants
1 Workshop to discuss the 07.04.2016 07.04.2016 1 11
modalities to roll out the
Bedaquiline conditional &
expanded access programme
2 RNTCP sensitization of 11.04.2016 11.04.2016 1 15
Nursing Students from
RAKCON School of Nursing
69
3 Sensitization programme for 18.04.2016 18.04.2016 1 68
medical Students of Mulana
Azad Medical college under
RNTCP
4 Workshop for DTO’s for 25.04.2016 25.04.2016 1 11
CBNAAT labs on quarterly
performance for CBNAAT
monitoring indicators
5 Sensitization programme for 26.04.2016 26.04.2016 1 22
DOT Providers under RNTCP
and review for project “SMS
for sure”
6 Sensitization programme for 27.04.2016 27.04.2016 1 18
Lab. Technicians under
RNTCP and performance for
CBNAAT monitoring
indicators under RNTCP
(Batch-I)
7 Sensitization programme for 28.04.2016 28.04.2016 1 21
Lab. Technicians under
RNTCP and performance for
CBNAAT monitoring
indicators under RNTCP
(Batch-II)
8 Training programme for 29.04.2016 29.04.2016 1 37
DTO’s on guidelines for
involvement of private
practitioners and partnership
programme under RNTCP
9 Continuing Medical 07.05.2016 07.05.2016 1 27
Education (CME) programme
under notification project
for private practitioners for
Narela District
10 Workshop cum review meet 11.05.2016 11.05.2016 1 31
on various projects with
DTO’s and medical officers
for Delhi State.
11 Sensitization programme for 12.05.2016 12.05.2016 1 32
medical Students of Mulana
Azad Medical college under
RNTCP
12 Delhi State workshop cum 18.05.2016 18.052016 1 36
review meet on TB/HIV
70
co-ordinators with DTOs and
medical officers.
13 Sensitization programme for 19.05.2016 19.05.2016 1 7
Night shelter care takers of
Narela District
14 Delhi State sensitization 20.05.2016 20.05.2016 1 8
programme for Night shelter
care takers for District
Gulabi Bagh
15 Sensitization programme for 20.05.2016 20.05.2016 1 5
Night shelter care takers of
District SPM Hospital
Shastri Park
16 Skill training programme for 23.05.2016 27.05.2016 5 16
DRTB Counsellors on TB
control under RNTCP
17 Continuing Medical 24.05.2016 24.05.2016 1 21
Education (CME) programme
under notification project for
private practitioners of
District Jhandewalan
18 Continuing medical 26.05.2016 26.05.2016 1 14
education (CME) programme
under notification project
for private practitioners of
District SPMarg Pilli Kothi
19 Sensitization programme 26.05.2016 26.05.2016 1 12
for Night shelter care takers
of District Sanjay Gandhi
20 Sensitization programme for 27.05.2016 27.05.2016 1 10
Night shelter care takers of
Jhandewalan District under
RNTCP
21 sensitization programme for 27.05.2016 27.05.2016 1 13
Night shelter care takers for
Shastri Park District under
RNTCP
22 Continuing medical 31.05.2016 31.05.2016 1 20
education (CME) programme
under notification project
for medical officers for
District -JPC Hospital &
Chest Clinic
71
23 RNTCP sensitization for 01.06.2016 01.06.2016 1 15
Nursing Students of
Safdarjung college for Nursing
24 Sensitization programme 02.06.2016 02.06.2016 1 8
for Night shelter care takers
of District Karawal Nagar
25 Sensitization programme 03.06.2016 03.06.2016 1 10
for Night shelter care takers
of District Kingsway Camp
Hospital
26 Delhi State sensitization 03.06.2016 03.06.2016 1 9
programme for Night
shelter care takers of
District NDMC Poly Clinic
27 Sensitization programme 09.06.2016 09.06.2016 1 12
for Night shelter care takers
of District DDU Hospital
28 Delhi State sensitization 10.06.2016 10.06.2016 1 10
programme of Night shelter
care takers of District
Lok Nayak
29 Sensitization programme for 10.06.2016 10.06.2016 1 14
Night shelter care takers of
District Nehru Nagar
30 Continuing Medical 13.06.2016 13.06.2016 1 9
Education (CME) programme
under notification project
for medical officers of SBS
Marg District NDMC
Poly Clinic
31 Sensitization programme for 14.06.2016 14.06.2016 1 68
medical students of Mulana
Azad Medical college under
RNTCP
32 Sensitization programme for 17.06.2016 17.06.2016 1 14
Night shelter care takers of
District Moti Nagar
33 Sensitization programme for 17.06.2016 17.06.2016 1 7
Night shelter care takers of
District NITRD
34 Sensitization programme for 18.06.2016 18.06.2016 1 5
Night shelter care takers of
District BSA Hospital
72
35 Sensitization programme for 24.06.2016 24.06.2016 1 8
Night shelter care takers of
District Patparganj
36 Sensitization programme for 24.06.2016 24.06.2016 1 12
Night shelter care takers of
District GTB
37 Sensitization programme for 25.06.2016 25.06.2016 1 10
Night shelter care takers for
District Ch. Des Raj Hospital
38 Continuing Medical 28.06.2016 28.06.2016 1 22
Education (CME) programme
under notification project of
medical officers
39 Sensitization programme for 29.06.2016 29.06.2016 1 25
Night shelter care takers of
District BJRM Hospital
40 Sensitization programme for 30.06.2016 30.06.2016 1 8
Night shelter care takers of
District Shahdara
41 Workshop on Delhi PMDT 01.07.2016 01.07.2016 1 9
scale up plan meeting under
the RNTCP
42 Sensitization programme for 11.07.2016 11.07.2016 1 20
medical Students of Mulana
Azad Medical college under
RNTCP
43 Training programme for 25.07.2016 26.07.2016 2 31
District TB officers on daily
Anti Tuberculosis treatment
and 3 I’s strategy under TB-
HIV collaboration activities
44 Training programme for 04.08.2016 05.08.2016 2 22
Medical officers on daily Anti
Tuberculosis treatment and
3 I’s strategy under TB-HIV
collaboration activities
45 Training programme for 08.08.2016 09.08.16 2 25
Medical officers on daily
Anti Tuberculosis treatment
and 3 I’s strategy under
TB-HIV collaboration
activities
73
46 Sensitization programme 10.08.2016 10.08.2016 1 24
for project SMS for sure,
Case Notification programme
along with RNTCP review
meeting
47 Sensitization programme for 16.08.2016 16.08.2016 1 68
medical Students of Mulana
Azad Medical college under
RNTCP
48 Sensitization programme 17.08.2016 17.08.2016 1 34
regarding performance of
PMDT and review under
RNTCP
49 RNTCP sensitization of 20.08.2016 20.08.2016 1 31
Nursing Students of Bsc (H)
4th year student from School
of Nursing
50 Training programme for STS 22.08.2016 22.08.2016 1 18
on daily Anti Tuberculosis
treatment and 3 I’s strategy
under RNTCP/NACO
programme
51 Training programme for STS 23.08.2016 23.08.2016 1 17
on daily Anti Tuberculosis
treatment and 3 I’s strategy
under TB-HIV collaboration
activities
52 Training programme for 26.08.2016 26.08.2016 1 16
TBHVs for Anti Tuberculosis
treatment on daily regimen
under RNTCP
53 Training programme for 29.08.2016 29.08.2016 1 25
Dots Plus TB HIV supervisors
on daily Anti Tuberculosis
treatment and 3 I’s strategy
under TB-HIV collaboration
activities
54 Training programme for Dots 30.08.2016 30.08.2016 1 20
Plus/STLS on daily Anti
Tuberculosis treatment and
3 I’s strategy under TB-HIV
collaboration activities
55 Training programme for 31.08.2016 31.08.2016 1 17
STLS on daily Anti
74
Tuberculosis treatment and
3 I’s strategy under TB-HIV
collaboration activities
56 Sensitization for SOSVA 07.09.2016 07.09.2016 1 11
Non government organisation
staff under RNTCP
57 Sensitization programme for 12.09.2016 12.09.2016 1 18
medical students of Mulana
Azad Medical college under
RNTCP
58 RNTCP sensitization for 03.10.2016 03.10.2016 1 26
Nursing Students for Bsc (H)
1st year students from Holy
Family School for Nursing
59 RNTCP sensitization for 03.10.2016 03.10.2016 1 28
Nursing Students for Bsc (H)
1st year student from Holy
Family School of Nursing
60 Workshop cum training on 07.10.2016 07.10.2016 1 33
financial management
(account) under RNTCP
programme
61 Sensitization programme for 10.10.2016 10.10.2016 1 70
medical students of Mulana
Azad Medical college under
RNTCP
62 Meeting on State operational 15.11.2016 15.11.2016 1 19
Research committee activities
under RNTCP programme.
63 Sensitization programme for 17.11.2016 17.11.2016 1 20
medical students of Mulana
Azad Medical college under
RNTCP
64 RNTCP sensitization for 07.12.2016 07.12.2016 1 24
Nursing students for Bsc (H)
2nd year student from
Safdarjang Hospital
New Delhi
65 RNTCP sensitization for 07.12.2016 07.12.2016 1 23
Nursing Students for Bsc (H)
2nd year student from
Safdarjang Hospital
New Delhi
75
66 Sensitization programme on 09.12.2016 09.12.2016 1 15
SMS sure programme under
RNTCP
67 Sensitization programme for 12.12.2016 12.12.2016 1 18
medical Students of Mulana
Azad Medical college under
RNTCP
68 Delhi state meeting cum 26.12.2016 26.12.2016 1 27
elaborate Active case finding
on nationwide case finding
campaign on ACF
69 Video conference workshop 04.01.2017 04.01.2017 1 87
on Active Case Finding for
DTO’s, Medical officers, STS,
STLS under ECHO project
70 Sensitization programme for 16.01.2017 16.01.2017 1 18
medical students of Mulana
Azad Medical college under
RNTCP
71 Training cum observatory 19.01.2017 19.01.2017 1 38
program on Active Case
Finding survey by Central
TB Division under RNTCP
72 Inauguration for Active Case 23.01.2017 23.01.2017 1 173
Finding (ACF) campaign via
ECHO project
73 RNTCP Modular Training 23.01.2017 03.02.2017 10 11
programme for Lab.
Technicians working under
Delhi Government
Dispensaries
74 RNTCP sensitization for 27.01.2017 27.01.2017 1 14
Nursing Students for Bsc (H)
1st year from Holy Family
School of Nursing
75 Meeting on active case 01.02.2017 01.02.2017 1 178
finding (ACF) via ECHO
programme to share
experiences for the campiagn
and suggestion under RNTCP
76 Nationwide video conference 08.02.2017 08.02.2017 1 152
workshop on Active Case
Finding under RNTCP
76
77 RNTCP sensitization of 03.02.2017 03.02.2017 1 22
Nursing Students from Bsc (H)
1st year students from Holy
Family School of Nursing
78 Training cum workshop 13.02.2017 13.02.2017 1 28
program for VIHAN
Volunteers on Active Case
Finding survey programme
for Red light Area under
RNTCP
79 Training cum workshop 14.02.2017 14.02.2017 1 28
program for VIHAN
Volunteers & Area
coordinators of DSACS on
Active Case Finding survey
program for Red light Area
under RNTCP
80 Sensitization programme for 15.02.2017 15.02.2017 1 67
medical students of Mulana
Azad Medical college under
RNTCP
81 Active Case finding among 20.02.2017 20.02.2017 1 11
PLHIV in high risk group area
82 Training of Data Entry 21.02.2017 21.02.2017 1 12
operators (DEO’s) on new
modules in Nikshay portal
83 Training of Data Entry 23.02.2017 23.02.2017 1 11
operators (DEO’s) on new
modules in Nikshay portal
84 Sensitization on active case 23.02.2017 23.02.2017 1 37
finding activity in high risk
population
85 Sensitization on World TB 08.03.2017 08.03.2017 1 34
Day Celebration activities
and review meeting on
quarterly performance of
Delhi State
86 Review of Active case finding 14.03.2017 14.03.2017 1 9
campaign in G.B.Road area
under RNTCP programme
87 PMDT review meeting of 16.03.2017 16.03.2017 1 38
Delhi State under RNTCP
programme
77
88 Sensitization programme for 17.03.2017 17.03.2017 1 19
medical Students of Mulana
Azad Medical college under
RNTCP
89 RNTCP Modular Training 20.03.2017 30.03.2017 10 9
programme for Lab.
Technicians working under
Delhi Government
Dispensaries
90 Final meeting on active 31.03.2017 31.03.2017 1 11
case finding (ACF) among
CSW at GB road under
RNTCP
Total 115 2439
Personnel trained/ Sensitizated under RNTCP during 2016-17 of
New Delhi TB Centre
Training for various Category No. of No. of No. of
Training Days Participants
batches training attended
done training
DTOs and Medical Officers 13 13 838
Senior TB Supervisors (STS) 9 9 230
Senior TB Lab Supervisors (STLS) 6 6 183
Laboratory Tech. 4 29 61
Dot Providers 3 3 66
Nursing Staff 9 9 198
Data Entry Operators (DEOs) 2 2 23
DRTB Supervisors 9 9 77
Medical Students 11 11 488
Others Staff 24 24 275
Total 90 115 2439
78
90 training sessions were conducted at New Delhi TB Centre-STDC
in 115 days and 2439 personnel, which included programme
managers, Medical officers, ground level RNTCP staff (STS/STLS, lab
technician, Data entry operator), Nurses, Para-medicals, PG-Students
and interns from various government as well as private institutions
were trained / sensitized on various aspects of RNTCP.
Analysis of Quarterly Cohort Reports
Compilation and preparation of quarterly reports (Sputum Conversion,
Treatment Outcome and Programme management) of all chest clinics
under RNTCP of Delhi state and their feedback is one of the major
activities of STDC. The analysis of the quarterly report for each chest
clinic in Delhi is carried out and the feedback, which includes
necessary instructions for improvement is prepared and are discussed
at the quarterly review meetings with the District TB Officers. All
these feedbacks and complied reports of the state are sent to the
DTOs and copies of these are also submitted to State TB Control
Officer and to Central TB Division, Ministry of Health & Family Welfare.
79
Chest Clinic wise performance of RNTCP in Delhi State: CASE NOTIFICATION
IN 2016 from Public Sector
S. Chest Clinic Papulatuion TB Pulmo- % Extra % New TB % New Previously %No. (Lakhs) Patients nary Pulmo- Pulmo- Extra Case TB Case Treated Previously
notified nary nary Pulmo- Treatedfrom nary
publicSector
1 Bijwasan 9.5 1620 957 59 663 41 1247 77 373 23
2 BJRM 5.3 1685 1023 61 662 39 1313 78 372 22
3 BSA Rohini 5.7 2477 1418 57 1059 43 2059 83 418 17
4 Ch Desraj Rohini 5.7 1584 965 61 619 39 1271 80 313 20
5 DDU 11.4 3564 1943 55 1621 45 2873 81 691 19
6 GTBH 5.9 2213 1247 56 966 44 1733 78 480 22
7 Gulabi Bagh 9.8 703 383 54 320 46 573 82 130 18
8 Hedgewar 5.1 717 365 51 352 49 575 80 142 20
9 Jhandewalan 5.8 1290 748 58 542 42 913 71 377 29
10 Karawal Nagar 8.2 3804 2042 54 1762 46 3027 80 777 20
11 KCC 7.9 1690 1021 60 669 40 1337 79 353 21
12 LNH 5.3 863 448 52 415 48 674 78 189 22
13 NITRD 10 1959 1241 63 718 37 1608 82 351 18
14 Malviya ngr 5.3 2682 1644 61 1038 39 2168 81 514 19
15 Moti Nagar 6.3 4049 2339 58 1710 42 3125 77 924 23
16 Narela 6.4 2423 1566 65 857 35 1826 75 597 25
17 NDMC 7 2736 1626 59 1110 41 2139 78 597 22
80
18 Nehru Nagar 11.4 5045 3018 60 2027 40 3959 78 1086 22
19 Patparganj 8.1 3518 2036 58 1482 42 2859 81 659 19
20 R.K.Mission 8.4 494 322 65 172 35 371 75 123 25
21 RTRM 5.5 1714 1073 63 641 37 1352 79 362 21
22 SGM 7.3 2180 1245 57 935 43 1780 82 400 18
23 Shahdara 6.3 2162 1173 54 989 46 1592 74 570 26
24 SPM 6.5 951 536 56 415 44 679 71 272 29
25 JPC Hospital 5.7 3534 1645 47 1889 53 2687 76 847 24
Total 179.8 55657 32024 57.76 23633 42.24 43740 78.24 11917 21.76
26 DTBA’s Pavement Homeless
Dwellers Project People 102 97 95 5 5 63 62 39 38
A total 179.8 lakh population was covered by 25 Chest clinics operating in Delhi and 55657 TB
patients were notified from public sector during 2016. Out of which 32024 (57.5%) were pulmonary
TB cases and 23,633 (42.5%) were extra pulmonary TB cases. In all, 43740 new TB cases were
notified from Delhi State from all the chest clinics.
81
Chest Clinic wise annual performance of RNTCP in Delhi State:
CASE NOTIFICATION IN 2016 from Private Sector
S. Chest Clinic TB % TB Total Annual Annual Total
No. Patients Patients TB Pts. TB Notifi- TB Annual
Notified Notified Notified cation Notifi- TB
from Pvt. from Pvt. Rate cation Notifi-
Sector Sector (Public Rate cation
from total Sector) (Private (Pub+
TB cases Sector) Prevate)
1 Bijwasan 0 0 1620 169 0 169
2 BJRM 122 7 1807 318 23 341
3 BSA Rohini 10 0 2487 432 2 434
4 Ch Desraj Rohini 1135 42 2719 276 198 474
5 DDU 80 2 3644 311 7 318
6 GTBH 29 1 2242 372 5 377
7 Gulabi Bagh 49 7 752 71 5 76
8 Hedgewar 43 6 760 141 8 149
9 Jhandewalan 88 6 1378 220 15 235
10 Karawal Nagar 0 0 3804 462 0 462
11 KCC 56 3 1746 213 7 220
12 LNH 231 21 1094 164 44 208
13 LRS 1416 42 3375 196 141 337
14 Malviya ngr 381 12 3063 507 72 579
15 Moti Nagar 784 16 4833 637 123 760
16 Narela 35 1 2458 381 6 387
17 NDMC 510 16 3246 389 72 461
18 Nehru Nagar 266 5 5311 442 23 465
19 Patparganj 144 4 3662 435 18 453
20 R.K.Mission 1052 68 1546 58 124 182
21 RTRM 201 10 1915 312 37 349
22 SGM 32 1 2212 299 4 303
23 Shahdara 79 4 2241 344 13 357
24 SPM 97 9 1048 147 15 162
25 JPC Hospital 209 6 3743 617 36 653
Total 7049 11.56 62706 7913 998 8911
26 DTBA’s Pavement — — 102 25 — 25
Dwellers Project
Case notification from Private sector across Delhi State is a major concern underRNTCP. During 2016, 7049 tuberculosis cases were notified from private sectoracross all the 25 chest clinics of Delhi State. About 12% cases were detected fromthe private sector of the total TB cases notified during 2016 from Delhi State fromthe total TB cases. Annual case notification rate was 357 of which 317 was frompublic sector and 40 was from private sector.
82
Chest Clinic-wise annual performance of RNTCP in Delhi State :
Diagnosed cases (Clinical & Microbiological in 2016)
S. Chest Clinic Micrro- % Micrro- Clinically % Pediatrict %
No. biological biological Diagnosed Clinically TB Pediatrict
Confirmed Confirmed Diagnosed TB
1 Bijwasan 677 42 943 58 150 9
2 BJRM 680 40 1005 60 177 11
3 BSA Rohini 809 33 1668 67 278 11
4 Ch Desraj Rohini 586 37 998 63 232 15
5 DDU 1273 36 2291 64 445 12
6 GTBH 818 37 1395 63 272 12
7 Gulabi Bagh 253 36 450 64 88 13
8 Hedgewar 274 38 443 62 87 12
9 Jhandewalan 494 38 796 62 172 13
10 Karawal Nagar 1240 33 2564 67 491 13
11 KCC 665 39 1035 61 155 9
12 LNH 267 31 596 69 135 16
13 LRS 871 44 1088 56 188 10
14 Malviya ngr 1136 42 1546 58 310 12
15 Moti Nagar 1426 35 2623 65 467 12
16 Narela 992 41 1431 59 233 10
17 NDMC 1086 40 1650 60 271 10
18 Nehru Nagar 1905 38 3140 62 539 11
19 Patparganj 904 26 2614 74 466 13
20 R.K.Mission 235 48 259 52 67 14
21 RTRM 842 49 872 51 144 8
22 SGM 592 27 1588 73 278 13
23 Shahdara 697 32 1465 68 304 14
24 SPM 350 37 601 63 122 13
25 JPC Hospital 838 24 2696 76 606 17
Total 19910 36.92 35757 63.08 6677 12.12
26 DTBA’s Pavement
Dwellers Project 85 83 17 17 — —
83
As per latest treatment guideline under RNTCP in 2016, the treatment
indicators have been classified as microbiologically confirmed TB case
i.e. presumptive TB patient with biological specimen positive for AFB or
positive for MTB on culture or positive for TB through Quality Assured
Rapid Diagnostic molecular test. In 2016, a total of 19910 (37%)
microbiological confirmed TB cases were put on treatment from all the
25 chest clinics of Delhi.
Clinically diagnosed TB case wherein a presumptive TB case who is not
microbiologically confirmed but diagnosed active TB by a clinician on the
basis of X-rays, histopathology or clinical signs. In 2016, 35757 (63%)
were clinically diagnosed as TB cases from all the 25 chest clinics of
Delhi State.
Pediatric TB case which is based on the presence of abnormalities
consistence with TB on radiography, history of exposure to an infections
case, evidence of TB infection (Positive TST) and clinical findings
suggestive of TB in event of negative or unavailable microbiological results.
In 2016, a total of 6677 (12%) pediatric TB cases were diagnosed from all
the 25 chest clinics of Delhi State. Thus, in all a total of 62344
tuberculosis cases were diagnosed from all the 25 chest clinics of Delhi
State during 2016.
84
85
86
SUPERVISORY ACTIVITIES
Monitoring and evaluation is an important tool for RNTCP. As State
TB Training & Demonstration Centre (STDC), the faculty of the Centre
is actively involved in monitoring and supervision of the TB control
programme at national and state level.
(A) State Internal Evaluation
The internal evaluation of all the chest clinics is an important activity
under the RNTCP where in all aspects of the clinic records, staff,
drug stores, microscopic activities, facilities and financial aspects are
evaluated in detail. Internal evaluation is organized by State TB
Control Department. Director of STDC or his nominee is the member
of internal evaluation team for all the chest clinics of Delhi. The
internal evaluation is carried out in two chest clinics of the state in
every quarter. During the year 2016-17, faculty from NDTB Centre
participated in evaluation of chest clinic as per the following schedule:
Faculty Date of Visits Chest Clinic
Dr. Shanker Matta 18th to 21st April, Shahdara Chest
2016 Clinic
(B) Supervisory Visits to Chest Clinics
Monitoring and supervision activities are implemented to ensure that
activities are conducted as planned, and that the data recorded and
reported is accurate and valid. It provides a feedback system for
remedial action to improve performance and in turn improve the
programme indicators. It also serves as a tool for continuous “on the
job sensitization” of the staff and increase the involvement and
commitment of the higher level authorities, both at the state and the
district level.
During the year 2016-17, the following Supervisory visits were made
by the doctors who gave their inputs to the improve programme
performance under RNTCP:
87
Faculty Date of Visits Chest Clinic
Dr. Shanker Matta 11/4/2016 RKM Chest Clinic
Dr.K.K.Chopra 18/6/2016 BSA Chest Clinic
Dr.K.K.Chopra 25/6/2016 Ch. Des Raj Chest Clinic
Dr. K.K. Chopra 29/6/2016 BJRM Chest Clinic
Dr. Shanker Matta 13/7/2016 Shastri Park Chest Clinic
Dr. Shanker Matta 14/7/2016 Kingsway Camp Chest Clinic
Dr. Shanker Matta 27/9/2016 Bijwasan Chest Clinic
Dr.K.K.Chopra 24/1/2017 BSA Chest Clinic
Dr. K.K.Chopra 24/1/2017 Ch. Des Raj Chest Clinic
Dr. Shanker Matta 30/1/2017 Hedgewar Chest Clinic
Dr. Shanker Matta 30/1/2017 Shahdara Chest Clinic
Dr. K.K.Chopra 31/1/2017 BJRM Chest Clinic
Dr. K.K. Chopra 29/3/2017 Ch. Des Raj Chest Clinic
LIABRARY AND INFORMATION SERVICES
The website of New Delhi TB Centre (www.ndtbc.com) has information
about various facilities and activities undertaken by the Centre along
with list of publications from the institute since 1940. The Centre
maintains a library which has 660 books on various aspects related
to tuberculosis and chest diseases. In addition, it has various National
and International journals. The library renders its services to the
students of MAMC and V.P.Chest Institute as well as the faculty of
the Centre.
88
(A) VISITORS TO NDTB CENTRE
1. Members of Board of Directors of FIND headquarters, Geneva
visited NDTB Centre on 13th April 2016. Dr. K.K. Chopra,
Director presented the activities of NDTB Centre and Dr. M
Hanif, Microbiologist briefed about the laboratory activities. This
was followed by discussion on role of FIND in establishing
laboratory network in India and its impact on TB situation.
They also made a visit to the laboratory.
2. A team of audit visited lab of NDTB Centre for review of paediatric
CBNAAT project on 25th April 2016. Activities of the project
were audited.
3. A team of Global Fund for audit of its activities in India visited
Delhi state on 26th April 2016. All the activities and records of
STDC and IRL were audited and discussed.
4. A team from FIND head office in Geneva visited the laboratory
of New Delhi TB Centre on 30th May 2016. The team reviewed
the laboratory activities in technical collaboration with FIND.
5. Two member team from NRL – NITRD comprising of One
Microbiologist and One Laboratory Technician visited laboratory
for three days for Annual On- Site Evaluation from 15th – 17th
June, 2016.
6. A team from NRL – NITRD, Mehrauli comprising of two
Microbiologist visited laboratory on 9th September, 2016 for
laboratory evaluation.
7. Dr. Paul Arthu Jensen from Centre for Global Health visited
the laboratory of the Centre on 20th October 2016. During the
visit he reviewed about bio safety in laboratory and gave
recommendations on infection control in the laboratory.
8. Two days laboratory assessment visit on 23rd – 24th November,
2016 was carried out by Dr. Sanjeev Saini, Microbiologist from
ADMINISTRATION
89
FIND.
9. Two microbiologists and two Lab. Technician of Jamia Medical
College visited laboratory of NDTB Centre on 27th Feb, 2017.
They were briefed about the processes of case detection and
Drug Sensitivity testing procedures adopted under RNTCP.
10. A team of NABL assessors visited laboratory of NDTB Centre for
conducting Pre assessment on accreditation of the laboratory
on 3rd and 4th February, 2017. They assessed infrastruction
and Human Resources of the laboratory and inspected the SOPs
and calibration of laboratory equipments. They suggested some
non-conformities to be completed in one month before visit by
NABL accreditation team.
11. A team of Afghanistan TB Officials accompanied by Dr. Sundari
from WHO visited laboratory on 6th March, 2017 for understanding
TB diagnosis and control programme under RNTCP.
12. A team of international and national parliamentarians visited
NDTB Centre on 7th March 2017. The visit was organised by
The Union. The purpose of the visit was to familiarize the
honourable parliamentarians with advanced TB diagnostic and
treatment services available in India and to familiarize them
with the basic diagnostic and treatment facilities available at
the district and sub –district level. Dr. K.K. Chopra, Director
and Dr. M. Hanif, Microbiologist briefed them about the
structure of TB control in India and laboratory diagnostic
facilities available at the state level.
(B) GRANTS
i. During the year 2016-17, the Government of India, Ministry of
Health & Family Welfare released the annual recurring grant-
in-aid (Salaries) of Rs. 310 Lacs and grant-in-aid (General) of
Rs. 37.34 Lacs.
ii. Rs. 10,000/- was provided by Tuberculosis Association of India
as annual grant.
90
(C) DONATIONS
Donations received (through TAI) for medicines
- (Anar Singh Chanchal Singh Memorial Fund Rs. 12,490/-
- Smt. Ram Piyari Dutt Memorial Fund
- Donation, Interest on FDR and saving Rs. 41,545/-
Bank Account
Total Rs. 54,035/-
(D) RIGHT TO INFORMATION ACT 2005
During 2016-17, 46 applications have been received under RTI Act,
2005. The table gives the details of applications received and disposed.
Table: Details of yearly Receipts & Disposal of RTI applications
for 2016-17
S. Month & RTI Applications Appeal Amount
No. Year of Fee
Paid
No. of No. of In No. of No. of In
RTI RTI Process Appeals Appeals Pro-
applica- applica- received disposal cess
tions tions
received disposal
1 April, 16 11 11 - - - - -
2 May,16 5 5 - - - - -
3 June,16 1 1 - - - - -
4 July, 16 11 11 - - - - -
5 August, 16 4 4 - - - - -
6 Sept, 16 1 1 - - - - -
7 Oct, 16 2 2 - - - - -
8 Nov,16 5 5 - - - - -
9 Dec,16 3 3 - - - - -
10. Jan,17 2 2 - - - - -
11. Feb,17 1 1 - - - - -
Total 2016-17 46 46 - - - - -
91
An insight of annual statistics of the Center are as follows:
Outpatient Attendance
New outpatients attendance 10157
Revisits 9895
Total outpatients attendance 20052
DOT Centre Attendance
New Patient put on DOTS at NDTB DOT Centre 17
Total Patients (2015-16) put on DOTS at NDTB 455
DOT Centre
Special Clinics Attendance
Special clinics (TB and Diabetes, HIV and TB, COAD 562
and Tobacco Cessation Clinic- Total New+old cases
Laboratory Examinations
Total laboratory examinations 35782
Total Smear Examination 35782
3. Culture Examination
(a) Solid Culture 5725
(b) Liquid Culture 4860
4. Drug susceptibility test
(a) by solid culture method 215
(b) by Liquid Culture Method 1062
(c) by LPA 5066
SUMMARY OF ACTIVITIES OF
NEW DELHI TB CENTRE
92
5 CBNAATa.
Examinations 13363
Tuberculin skin tests
Total Tuberculin skin tests done 8425
Tests read 7451
Reactors (>10mm) 3352
Non-reactors (<10mm) 4099
Radiological Examinations
Radiological Examinations 1561
Trainings/IRL Visits/Publications
Personnel trained 2439
Supervision and Monitoring /Internal 14
Evaluation of Chest Clinics
IRL Visits to chest clinics for EQA 21
Presentations of papers in conference 6
Research and Publications 7
93
THAKUR, VAIDYANATH AIYAR & CO. 221-223, Deen Dayal Marg, New Delhi-02
Chartered Accountants Phones : 91 - 11-23236958-60, 23237772
New Delhi, Mumbai, Kolkata, Chennai Fax : 91 - 11-23230831
Patna and Chandigarh Email : [email protected]
Independent Auditor’s Report
To the Members of
New Delhi Tuberculosis Center,
We have audited the accompanying financial statements of New Delhi
Tuberculosis Center which comprise the Balance Sheet as at March
31, 2017, the Statement of Income and Expenditure for the year
then ended, and a summary of significant accounting policies and
other explanatory information.
Management’s Responsibility for the Financial Statements
Management is responsible for the preparation of these financial
statements that give a true and fair view of the financial position and
financial performance of the Centre in accordance with the Accounting
Standards, to the extent applicable, issued by the Institute of
Chartered Accountants of India. This responsibility includes the
design, implementation and maintenance of internal control relevant
to the preparation and presentations of the financial statements that
gives a true and fair view and are free from material misstatement,
whether due to fraud or error.
Auditor’s Responsibility
Our responsibility is to express an opinion on these financial
statements based on our audit. We conducted our audit in accordance
with the Standards on Auditing issued by the Institute of Chartered
Accountants of India. Those Standards require that we comply with
ethical requirements and plan and perform the audit to obtain
reasonable assurance about whether the financial statements are
free from material misstatement.
94
An audit involves performing procedures to obtain audit evidence
about the amounts and disclosures in the financial statements. The
procedures selected depend on the auditor’s judgment, including
the assessment of the risks of material misstatement of the financial
statements, whether due to fraud or error. In making those risk
assessments, the auditor considers internal control relevant to the
Centre in preparation and fair presentation of the financial statements
in order to design audit procedures that are appropriate, but not for
the purpose of expressing an opinion on the effectiveness of the
Entity’s internal control. An audit also includes evaluating the
appropriateness of accounting policies used and the reasonableness
of the accounting estimates made by management, as well as
evaluating the overall presentation of the financial statements. We
believe that the audit evidence we have obtained is sufficient and
appropriate to provide a basis for our audit opinion.
Opinion
In our opinion and to the best of our information and according to
the explanations given to us, the financial statements read with
accounting policies and Notes given in Schedule 17 give the
information required by the Act in the manner so required and give a
true and fair view in conformity with the accounting principles
generally accepted in India:
a) in the case of the Balance Sheet, of the state of affairs of
the Centre as at March 31, 2017 and
b) in the case of the Statement of Income and Expenditure,
of the Surplus for the year ended on that date;
Report on Other Legal and Regulatory Requirements
a) We have obtained all the information and explanations
which to the best of our knowledge and belief were
necessary for the purpose of our audit;
95
b) In our opinion, proper books of account as required by
law have been kept by the Centre so far as appears from
our examination of those books;
c) The Balance Sheet , Statement of Income and
Expenditure dealt with by this Report are in agreement
with the books of account;
d) In our opinion, the Balance Sheet, Statement of Income
and Expenditure comply with the Accounting Standards,
to the extant applicable, issued by the Institute of
Chartered Accountants of India.
For Thakur, Vaidyanath Aiyar & Co.
Chartered Accountants
FRN: 000038N
(Anil K. Thakur)
Partner
M. No. : 088722
Place: New Delhi
Date : 28.09.2017
96
NEW DELHI TUBERCULOSIS CENTRE
BALANCE SHEET AS AT 31ST MARCH, 2017
Schedule As at As at
31.03.2017 31.03.2016————— ————— —————
(Rs.) (Rs.)
SOURCES OF FUNDS:
Assets Fund 1 3,372,606 3,518,730
Earmarked Funds 2 1,312,350 1,392,596
Current Liabilities and Provisions 3 4,793,769 6,094,812
Accumulated Deficit / Surplus 310,593 194,928
—————— ——————
Total 9,789,318 11,201,066
—————— ——————
APPLICATION OF FUNDS:
Fixed Assets 4 3,372,606 3,518,730
Current Assets, Loans & Advances 5 6,270,405 7,567,879
TDS recoverable 146,307 114,457
—————— ——————
Total 9,789,318 11,201,066
—————— ——————
Accounting Policies and Notes 17
to the accounts
Schedule Nos.1 to 17 form an integral part of the Accounts
As per our report of even date attached
For Thakur Vaidyanath Aiyer & Co.
Chartered Accountants
97
NEW DELHI TUBERCULOSIS CENTRE
STATEMENT OF INCOME AND EXPENDITURE FOR THE YEAR
ENDED 31ST MARCH 2017
Schedule For the year For the year 2016-17 2015-16
————— ————— ————— (Rs.) (Rs.)
INCOME
Recuring Grant from Govt.of India :
Grant-in-aid Salaries 31,000,000 30,400,000
Grant-in-aid General 3,734,000 3,300,000
Maintenance Grants from TAI 10,000 10,000
Fees from Patients 6 291,900 452,095
Misc. Receipts:
- Interest income 152,196 353,188
- Other receipts 1,270 30—————— ——————
Total 35,189,366 34,515,313—————— ——————
EXPENDITURE
Salary & Other Staff expenditure 7 30,880,412 30,319,752
Administrative Expenses 8 3,911,053 3,553,712
Expenses on X-Ray Films, Drugs
& Medicines and Lab. Consumable 9 282,236 416,186—————— ——————
Total 35,073,701 34,289,650—————— ——————
(Deficit)/Surplus for the year 115,665 225,663
Less / (Add) : Balance as per last account 194,928 (30,735)—————— ——————
310,593 194,928—————— ——————
Accounting Policies and Notes 17to the Accounts
Schedule Nos.1 to 17 form an integral part of the Accounts
As per our report of even date attached
For Thakur Vaidyanath Aiyer & Co.
Chartered Accountants
Accountant
(S.K. Saini)
Director
( Dr.K.K.Chopra)
(Anil K. Thakur) Chairman
Partner (Dr. L.S. Chauhan)
M. No. 088722
Place : New Delhi
Date : 28.09.2017
98
NEW DELHI TUBERCULOSIS CENTRE
RECEIPTS & PAYMENTS ACCOUNT FOR THE YEAR
ENDED MARCH 31, 2017
Schedule For the Year For the Year
2016-17 2015-16————— ————— —————
R E C E I P T S Rs.
Opening Cash & Bank Balances 5 7,396,262 6,420,045
Grants :
Recurring Grant-in Aid from
Govt. of India
- Grant-in-aid Salaries 31,000,000 30,400,000
- Grant-in-aid General 3,734,000 3,300,000
Maintenance Grants from TAI 10,000 10,000
Fee from Patients 6 291,900 444,545
Receipts from TAI 10 2,093,000 2,062,363
Other Receipts 11 520,197 1,813,428—————— ——————
Total 45,045,359 44,450,381—————— ——————
P A Y M E N T S
Staff Expenditure 12 30,764,262 30,250,711
Administrative expenses 13 4,036,912 3,626,918
X-Ray films,Drugs and Med. & 14 277,795 491,757
Lab. Consumables
Payments from TAI Fund 15 2,093,000 2,062,363
Other Payments 16 1,753,878 622,370
Closing Cash & Bank Balances 5 6,119,512 7,396,262—————— ——————
Total 45,045,359 44,450,381—————— ——————
Policies and Notes to the Accounts 17
Schedule Nos.1 to 17 form an integral part of the Accounts
As per our report of even date attached
For Thakur Vaidyanath Aiyer & Co.
Chartered Accountants
Accountant
(S.K. Saini)Director
( Dr.K.K.Chopra)
(Anil K. Thakur) ChairmanPartner (Dr. L.S. Chauhan)
M. No. 088722Place : New DelhiDate : 28.09.2017
99
NEW DELHI TUBERCULOSIS CENTRE
Schedule- 1
ASSETS FUND
As at As at
31.03.17 31.03.16
————— —————
(Rs.) (Rs.)
Balance as Per last A/c 3,518,730 4,666,162
Add : Additions during the year for Cost
of Assets Acquired (refer Schedule-4) 305,056 482,537
—————— ——————
38,23,786 5,148,699
—————— ——————
Less:
Disposals during the year - 1,161,239
Depreciation for the year 451,180 468,730
(refer Schedule - 4)
—————— ——————
Total 3,372,606 3,518,730
—————— ——————Schedule - 2
Unutilised Received / Interest Total Utilised Unutilised Balance Transferred during Balance
as on during the year as on 01.04.16 the year 31.03.17
(Rs.) (Rs.) (Rs.) (Rs.) (Rs.) (Rs.)
EARMARKED FUND
General Donations 336,073 10,000 41,720 387,793 - 387,793
Auditorium fund 114,893 10,000 - 124,893 123,885 1,008
For Poor Patients 56,566 - - 56,566 - 56,566
For Medicines 303,410 12,490 - 315,900 33,953 281,947
Staff Welfare Fund 83,054 - 3,382 86,436 - 86,436
Research Fund 498,600 - - 498,600 - 498,600
Total 1,392,596 32,490 45,102 1,470,188 157,838 1,312,350
100
NEW DELHI TUBERCULOSIS CENTRE
As at As at
31.03.17 31.03.16
————— —————
(Rs.) (Rs.)
Schedule- 3
Current Liabilities & Provisions
Advance Fee & Lab Charges 3,160 3,160
Salary & Allowances 2,712,532 2,478,599
Bonus 178,870 89,653
Other Payable 32,667 61,968
Sundry Creditors 17,415 121,897
Provision for Contribution to Gratuity Fund 205,000 412,000
Security Deposit 29,330 22,344
Unspent Project Balances :
Unspent Project Fund -SMS for Sure 929,153 1,573,953
Unspent Project Fund -Acceleration of TB notification 80,921 221,075
Unspent Project Fund -Framework of Tb care in prison 241,500 241,500
Unspent Project Fund -Genetic Polymprphism - 30,000
Unspent Project Fund -Xpert Ultra 363,221 838,663
—————— ——————
Total 4,793,769 6,094,812
—————— ——————
101
NEW DELHI TUBERCULOSIS CENTRE
Schedule - 4
Fixed Assets
WDV Additions Disposals Balance Depreciation Net
balance
as on during the year as on for the year on
01.04.16 31.03.17 31.03.17
————— ————— ————— ————— ————— —————
(Rs.) (Rs.) (Rs.) (Rs.) (Rs.) (Rs.)
Building 245,966 - - 245,966 24,597 221,369
Electrical 796,062 - - 796,062 79,606 716,456
Installations and
Sanitary Fittings
Furniture & 1,081,926 292,485 - 1,374,411 125,415 1,248,996
Fittings
Lab. Equipments 637,235 - - 637,235 95,585 541,650
X-ray Equipments 559,384 - - 559,384 83,908 475,476
Other Equipments 18,748 - - 18,748 2,812 15,936
Computer 18,926 12,571 - 31,497 15,127 16,370
Books 126 - - 126 76 50
Vehicle 160,357 - - 160,357 24,054 136,303
_________ _________ _________ _________ _________ _________
Total 3,518,730 305,056 - 3,823,786 451,180 3,372,606_________ _________ _________ _________ __________________
102
NEW DELHI TUBERCULOSIS CENTRE
As at As at
31.03.17 31.03.16
————— —————
(Rs.) (Rs.)
Schedule- 5
Current Assets & Loans and Advances
Stocks and Stores at cost :
(as valued and certified by the
Management)
-X-Ray films and chemicals 26,484 4,613
-Laboratory stains, chemicals glassware 88,409 1,18,315
Festival Advance 36,000 46,800
Universal Comfort Products Ltd - 1,889
————— —————Sub Total - A 150,893 171,617
————— —————
Cash and Bank Balances:
Cash in hand 2,870 290
(as certified by the Management)
In Current A/c with BOI 4,826,191 6,081,388
In Saving Bank
- with BOI ( Earmarked donation fund) 1,204,015 1,231,530
- with BOI (Staff Welfare Fund) 86,436 83,054
————— —————Sub Total - B 6,119,512 7,396,262
————— —————Gross Total - A+B 6,270,405 7,567,879
————— —————
103
NEW DELHI TUBERCULOSIS CENTRE
Advance Fee Add: Advance Fee for Advance
Fee Received fee adjusted the year as on
as on During During 2016-17 31.03.2017
01.04.16 the year the year
————— ————— ————— ————— —————
(Rs.) (Rs.) (Rs.) (Rs.) (Rs.)
Schedule-6
Advance Fees for patients
Laboratory 3,160 291,900 - 291,900 3,160
charges
X-ray charges - - - -
———–— ———–— ———— —–——— —————
Total 3,160 291,900 - 291,900 3,160
———–— ———–— ———— —–——— —————
For the year For the year
2016-17 2015-16
—————— ——————
(Rs.) (Rs.)
Schedule- 7
Salary & Other Staff Expenditure :
Salaries 9,849,117 10,850,949
Dearness Allowance 12,450,805 11,142,854
House Rent Allowance 2,866,947 2,774,027
Transport Allowance 1,792,848 1,720,282
Other Allowances 666,545 600,186
Children’s Education Allowances 333,700 343,252
Contribution to Provident Fund 2,212,268 2,152,950
Contribution to Gratuity Fund 205,000 412,000
Bonus 355,924 89,653
Travel Concession 147,258 233,599————–—— ————–——
Total 30,880,412 30,319,752————–—— ————–——
104
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2015-16 2014-15
—————— ——————
(Rs.) (Rs.)
Schedule- 8
Administrative Expenses :
Wages to Contractual staff 871,542 823,625
Wages toTemporary staff - 95,288
Security Charges 707,448 533,868
Staff Uniform 13,025 10,834
Medical Aid to staff 263,389 248,468
Travelling Expenses & Conveyance 28,104 48,865
Repairs to Furniture and equipment 121,535 85,244
Repairs to X-ray equipments 41,375 36,042
Repairs to Laboratory equipment 95,665 34,738
Telephone Expenses 130,658 131,290
Printing & Stationery 92,399 90,360
Postage 5,615 3,825
Laundry Charges 5,610 3,298
Books & Journals 860 -
Maintenance of car 40,294 39,184
Audit Fee 24,780 24,255
Miscellaneous expenses 107,953 95,393
Building maintenance expenses-civil 803,263 546,359
Building maintenance expenses-electrical 179,400 -
Annual day expenses 38,478 195,799
Legal expense 19,800 22,550
Linen and bedding - 1,890
Cost of Asets Aquired out of Grant 319,860 482,537
Fund Fund & Furniture Repairs etc————–—— ————–——
Total 3,911,053 3,553,712————–—— ————–——
105
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2016-17 2015-16
——————— ——————
(Rs.) (Rs.)
Schedule- 9
X-Ray Films ,Drugs and Medicines & Lab. Consumable
Drugs and Medicines
Balance as on 1.4.2016 -
Add : Purchased during the year 44,837
——————Less : Closing Stock - 44,837 48,150
——————
X-Ray Films and Chemicals
Balance as on 1.4.2016 4,613
Add : Purchased during the year 105,028
——————
109,641
Less : Closing Stock 26,484 83,157 1,01,843——————
Lab. Stains, Chemicals & Glassware
Balance as on 1.4.2016 118,315
Add : Purchased during the year 124,336
——————
242,651
Less : Closing Stock 88,409 154,242 266,193
——————
——————— ——————
Materials Consumed Total 282,236 416,186——————— ——————
106
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2016-17 2015-16
——————— ———————
Schedule- 10 (Rs.) (Rs.)
Receipts from TAI
For PF Advances 2,093,000 772,000
For Gratuity Payments - 335,054
For PF Payments - 955,309
——————— ———————Total 2,093,000 2,062,363
——————— ———————Schedule - 11
Other Receipts
Recovery of Festival Advance 69,300 62,100
Donations for Medicines 12,490 13,493
Staff Welfare Fund 3,382 3,224
Interest on FFD A/c 128,433 353,188
Interest on Saving A/c (Earmarked Fund ) 33,633 46,430
General Donation 10,000 -
Miscellaneous Receipts 1,270 30
Earnest money 25,000 -
Auditorium Fund 10,000
Project-Genetic Polymorphism - 30,000
Project-Acceleration of TB notification 224,800 224,800
Project-Framework of TB.care in prisons - 241,500
Project-Xpert Ultra - 838,663
universal comfort products ltd. 1,889 -——————— ———————
Total 520,197 1,813,428
——————— ———————
107
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2016-17 2015-16——————— ———————
Schedule- 12 (Rs.) (Rs.)
Staff Expenditure
Salaries 9,680,549 10,838,531
Dearness Allowance 12,455,119 10,867,447
House Rent Allowance 2,859,047 2,762,539
Transport Allowance 1,796,347 1,699,587
Other Allowances 614,978 595,399
Children’s Education allowance 333,700 343,252
Contribution to Provident Fund 2,198,557 2,123,277
Contribution to Gratuity Fund 412,000 695,000
Bonus 266,707 92,080
Travel Concession 147,258 233,599
——————— ———————
Total 30,764,262 30,250,711
——————— ———————
108
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2016-17 2015-16——————— ———————
Schedule- 13 (Rs.) (Rs.)
Administrative Expenses
Wages to Contractual staff 945,071 798,447
Wages to Temporary staff - 118,034
Security Charges 753,412 530,905
Staff Uniform 9,591 10,834
Medical Aid to staff 263,389 248,468
Travelling Expenses & Conveyance 28,104 48,865
Repairs to Furniture and equipment 121,535 85,244
Repairs to X- Ray equipment 41,375 36,042
Repairs to Laboratory equipment 93,414 35,755
Telephone Expenses 135,649 129,790
Printing & Stationery 92,399 90,360
Postage 5,615 3,825
Laundry Charges 5,610 3,298
Books & Journals 860 -
Maintenance of car 29,764 41,217
Audit Fee 24,150 24,045
Miscellaneous expenses 107,953 95,393
Building maintenance -civil 798,933 534,015
Building maintenance -Electrical 179,400 31,066
Annual day expenses 38,478 195,799
Furniture 319,860 484,426
Legal expenses 42,350 79,200
Linen and bedding - 1,890——————— ———————
Total 4,036,912 3,626,918——————— ———————
109
NEW DELHI TUBERCULOSIS CENTRE
For the year For the year
2016-17 2015-16——————— ———————
Schedule- 14 (Rs.) (Rs.)
X-Ray Films, Drugs and Medicines
& Lab. Consumable
X-Ray Films and Chemicals 105,028 103,462
Drugs and Medicines 44,837 48,150
Laboratory Stains and Chemicals 127,930 340,145——————— ———————
Total 277,795 491,757——————— ———————
Schedule- 15
Payments from TAI Fund
PF Advances 2,093,000 772,000
Gratuity Payments - 335,054
PF Payments - 955,309——————— ———————
Total 2,093,000 2,062,363——————— ———————
Schedule- 16
Other Payments
Festival advance 58,500 67,500
Earnest money - -
General donation - -
Staff Welfare Fund - -
Donation fo medicines 33,953 36,692
Auditorium funds 123,885 88,406
Ptoject-SMS for sure 644,800 426,047
Project-Acceleration of TB notification 364,954 3,725
Project-Xpert Ultra 475,442 -
Project Genetic Polymorphism 30,000 -
Security deposit 22,344 -——————— ———————
Total 1,753,878 622,370——————— ———————
110
NEW DELHI TUBERCULOSIS CENTRE
Annexure 1 (for the year ended 31st March 2017)
Grant-in-aid Grant-in-aid
Salaries General
——————— ———————
(Rs.) (Rs.)
INCOME
Opening suplus/(Deficit) (01.04.16) (6,675) 201,603
Grant-in-aid from Govt.of India 31,000,000 3,734,000
Maintenance Grants from TAI - 10,000
Fees from Patients - 291,900
Interest income - 152,196
Other receipts - 1,270
——————— ———————Total 30,993,325 4,390,969
——————— ———————
EXPENDITURE
Salary & Other Staff expenditure 30,880,412 -
Administrative Expenses - 3,911,053
Expenses on X-Ray Films, Drugs & Medicines
and Lab. Consumable - 282,236
——————— ———————
Total 30,880,412 4,193,289——————— ———————
Surplus/(Deficit) 112,913 197,680———————
Total Surplus as on 31.03.3017 310,593
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NEW DELHI TUBERCULOSIS CENTRE
Schedule – 17
Significant Accounting Policies and Notes to Accounts
A. Significant Accounting Policies :
1. Accounting Convention :
The Financial Statements have been prepared on accrual basis (except
as specifically stated) and under the historical cost convention, and in
accordance with the generally accepted accounting principles in India.
2. Use of Estimates:
The preparation of the Financial Statements in conformity with GAAP
in India requires management to make estimates and assumptions,
wherever necessary, that affect the reported amount of assets and
liabilities and contingent liabilities as at the date of financial statements
and the amount of revenue and expenses during the year. Actual results
could differ from those estimates. Any revision to such estimates is
recognized in the year in which the results are known / materialized.
3. Revenue Recognition :
Income & Expenditures have been accounted for on accrual basis
except for leave encasement.
4. Fixed Assets & Depreciation:
a) Fixed Assets are stated at cost, Assets received as donation
are stated at estimated market value on the date of
donation.
b) Centre has started charging Depreciation from the
Financial Year 2011-12 on its Fixed Assets as per rate
prescribed under Income Tax Act, 1961.
c) Further, Depreciation has been debited to the Assets
Fund by Crediting Cost of respective Fixed Assets.
d) Capital items having cost / value less than Rupees Five
Thousand are not capitalized.
e) Assets Fund has been credited with the cost/value of
Fixed Assets acquired during the year by debiting Income
& Expenditure account and / or Project Fund.
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5. Inventories :
Laboratory stains, chemicals and glassware and x-ray films & chemicals
are valued at purchase price following FIFO method (Refer Note No. 3).
6. Gratuity :
Liability for future payments of Gratuity has been provided for as per
the rules of Tuberculosis Association of India (TAI) and said Gratuity
Fund is also maintained by TAI.
7. Provident Fund :
As per rules of Tuberculosis Association of India (TAI), accounts relating
to Provident Fund of the staff of the Centre have been maintained by
the (TAI).
8. Interest Incomes :
Interests earned on the Investments of Earmarked Funds have been
credited directly to such Fund instead of Income & expenditure
Account.
B. Notes to Accounts
1. In absence of any demands from Lok Nayak Hospital for
Electricity and water expenses no liabilities have been provided
till the financial year 2015-16. However, from 2016-17 Lok Nayak
Hospital started raising bills for electricity charges only.
2. Title deed of the land on which Buildings are situated is not
available.
3. Cost / Value of stock are as valued and verified by the
Management.
4. In absence of PAN, Bank is deducting TDS on interest at higher
rate than the normal rate of TDS i.e. @ 20%. However, the
Centre has now got the PAN and accordingly from February
onwards normal rate has been applied by Bank for TDS.
5. Previous year’s figures have been regrouped / rearranged
wherever considered necessary.
Accountant Director Chairman
(S.K. Saini) (Dr. K.K. Chopra) (Dr. L.S. Chauhan)
Place: New Delhi
Date : 28.09.2017
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VISIT OF PARLIAMENTARIANS
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VISIT OF NABL ASSESSOR
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VISIT OF HIGHER GOVERNMENT DIGNITARIES
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WORLD TB WEEK CELEBRATION